Todd Ewen C D
National Food Safety and Toxicology Center, Michigan State University, 165 NFST Building, East Lansing, MI 48824, USA.
Mar Pollut Bull. 2006;53(10-12):569-78. doi: 10.1016/j.marpolbul.2006.08.004. Epub 2006 Sep 18.
Surveillance systems for foodborne disease vary in capacity by country, especially for marine-related illnesses. Generally, the more developed the country is, the more funding that is put into its surveillance programs, but no country has an outstanding system that could serve as a model for all others. An additional problem is lack of consistency. Approaches to surveillance and available resources change over time, so that apparent trends may reflect more of an administrative function. Most countries have some passive system that allows data on foodborne illnesses to be sent to centralized authorities where summaries are generated. However, these depend on the uneven quality of the source data that vary according to the resources allocated at the local level. Active surveillance systems collect data targeted to answer specific epidemiological questions more efficiently, but at such a high cost that most countries do not have the resources, except on a occasional basis. There is also the issue of what to do with the collected data. There has to be a conscious effort to translate the problems identified from the surveillance programs to consider strategies for prevention and control of foodborne disease. Otherwise, there is little value in having these kinds of monitoring programs. Another problem is lack of coordination in surveillance systems between most countries, so that information can be rapidly and efficiently shared. That being said, surveillance over the years had generated much interesting information on how disease agents are transmitted through the food supply, and where contamination and growth by pathogens in the food production and preparation chain typically occur. In addition, attempts are being made to create regional networks in different parts of the world usually initiated by organizations like WHO and PAHO. The kinds of information collected and programs being introduced are discussed in examples taken from both the developed and less developed world, followed by a series of recommendations for improving surveillance on a global basis. A recent burden in the surveillance system is the potential for a deliberate attack on the food supply with agents not usually involved with foodborne illness. At least in the US, a major concern is for the rapid detection and containment of a massive contamination of the food supply.
食源性疾病监测系统的能力因国家而异，特别是对于与海洋相关的疾病。一般来说，国家越发达，投入其监测项目的资金就越多，但没有一个国家拥有堪称典范、能供其他所有国家效仿的卓越系统。另一个问题是缺乏一致性。监测方法和可用资源会随时间变化，因此表面上的趋势可能更多反映的是行政职能。大多数国家都有某种被动系统，可将食源性疾病数据发送至中央机构进行汇总。然而，这些系统依赖于质量参差不齐的源数据，而源数据质量会因地方层面分配的资源不同而有所差异。主动监测系统收集有针对性的数据，以便更高效地回答特定的流行病学问题，但成本极高，以至于除偶尔情况外，大多数国家都没有足够资源采用。还有收集到的数据如何处理的问题。必须有意识地努力将监测项目中发现的问题转化为预防和控制食源性疾病的策略。否则，这类监测项目就没什么价值。另一个问题是大多数国家的监测系统之间缺乏协调，无法快速有效地共享信息。话虽如此，多年来的监测已产生了许多关于病原体如何通过食品供应传播，以及食品生产和制备链中病原体污染和生长通常发生在何处的有趣信息。此外，世界卫生组织和泛美卫生组织等机构通常会牵头在世界不同地区建立区域网络。本文将通过来自发达国家和欠发达国家的实例，讨论所收集的信息类型和引入的项目，随后提出一系列在全球范围内改进监测的建议。监测系统近期面临的一个负担是，存在使用通常与食源性疾病无关的病原体蓄意攻击食品供应的可能性。至少在美国，一个主要担忧是能否快速检测并控制食品供应的大规模污染。
