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Food Safety and Foodborne Disease Surveillance Systems: Proceedings of An Iranian-American Workshop Day 1 Morning Session     Overview of Food Safety Issues and of Diseases Arising from Food of Animal and Plant Origin in the United States         Overview of Safety Issues in Iran for Food Originating from Animals or Plants         The Role of the Institute of Standards and Industrial Research of Iran in Food Safety in Iran         Discussion    

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Food Safety and Foodborne Disease Surveillance Systems: Proceedings of An Iranian-American Workshop Overview of Food Safety Issues and of Diseases Arising from Food of Animal and Plant Origin in the United States Karl R. Matthews Department of Food Science, Rutgers University Food safety and foodborne diseases are topics of global concern. Food safety encompasses many areas, including pesticide and antibiotic residues, the presence of mycotoxins and foodborne pathogens, and all aspects of food production and preparation. Many issues associated with these topics are common to all countries. Decisions must be made by each nation to determine priority areas that should be addressed to ensure the health of its citizens. In the United States, despite significant strides in microbiological food safety, continued effort is required to combat this complex human health issue. The Centers for Disease Control and Prevention (CDC) estimates that 76 million persons in the United States annually contract foodborne illness (Mead et al., 1999). Surveillance data from the Foodborne Disease Active Surveillance Network (abbreviated as FoodNet) suggest that the infection incidence for target foodborne pathogens in the year 2003 was lower than the average annual incidence in the United States for the years 1996-1998 (Vugia et al., 2004). FoodNet determines the burden and sources of specific foodborne diseases by surveying laboratories in selected states. The estimated incidence of several infections declined significantly during the evaluation period. Infections decreased 49 percent, 42 percent, 28 percent, and 17 percent for Yersinia, Escherichia coli O157:H7, Campylobacter, and Salmonella, respectively. The incidence of Cryptosporidium infection decreased 51 percent. The incidence of Listeria and Shigella varied considerably during the observation period but did not change significantly. Only the incidence of Vibrio infections increased. The changes in incidence of the above infections occurred during a period when control measures were implemented with new or renewed effort by government agencies and the food industry. The U.S. Department of Agriculture

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Food Safety and Foodborne Disease Surveillance Systems: Proceedings of An Iranian-American Workshop (USDA) through its Food Safety Inspection Service (FSIS) launched Pathogen Reduction/Hazard Analysis and Critical Control Point (PR/HACCP) regulations for meat and poultry slaughter operations and processing plants in 1996. The U.S. Food and Drug Administration (FDA) introduced several intervention strategies designed to control foodborne diseases in the products they regulate. These include the produce safety guidance of 1998 (http://www.foodsafety.gov/~dms/prodguid.html), the sprout safety guidance of 1999 (http://www.isga-sprouts.org/sprougd1.htm), the requirements for refrigeration and safety labeling of shell eggs in 2001 (http://www.foodsafety.gov/~dms/fs-toc.html), and implementation of HACCP regulations for the seafood industry in 1997 (http://vm.cfsan.fda.gov/~lrd/fr951218.html) and the juice industry in 2002 (http://www.cfsan.fda.gov/~lrd/fr01119a.html). Food safety policies and practices must continue to evolve as new technologies, production practices, and food manufacturing processes are developed. The complex relationships among pathogens, the host, and the environment also ought to be taken into consideration when addressing foodborne illnesses. For the purposes of this paper, food safety and foodborne disease issues are categorized broadly as those of either animal or plant origin. The microbiological quality and safety of animal products is influenced by an array of factors. They include production practices, use of antibiotics, consumer demand, and the global nature of the marketplace. Meat animal production has increased significantly in the United States over the past 30 years. Concurrently, meat animal production practices have changed. Perhaps most notable is the change to higher-intensity production practices. Pathogenic microorganisms are more likely to spread among animals confined in a limited space (IFT, 2002). To ensure the health and promote the growth of livestock, antibiotics are often added to animal feed. Indeed, approximately one-half of the antibiotics produced today are added to animal feed (WHO, 2002). This may contribute to the development of antibiotic-resistant human pathogens that have animal reservoirs (Smith et al., 2005). The microbiological safety of meat and meat products requires concerted effort from government agencies, livestock producers, and meat processors. A number of well-publicized outbreaks of foodborne illness and recalls of meat and meat products have occurred during the past decade. Many millions of kilograms of ground beef and luncheon meat have been recalled because of potential contamination with E. coli O157:H7 and Listeria monocytogenes, respectively. A large outbreak in the early 1990s due to E. coli O157:H7 contaminated hamburgers resulted in four deaths and hundreds of illnesses; this prompted the development of the USDA/FSIS PR/HACCP rule mentioned above. Indeed, a single foodborne pathogen has completely changed the beef industry in the United States. The cost of concerns about E. coli O157:H7 contamination in beef production in the United States was estimated at a staggering $2.7 billion in the past 10

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Food Safety and Foodborne Disease Surveillance Systems: Proceedings of An Iranian-American Workshop years (Kay, 2003). This cost is associated with recalls, lost consumer demand, implementation of food safety intervention strategies, and increased operating expenses. The poultry industry has also experienced greater production expenses to control Salmonella and Campylobacter associated with poultry products and eggs. Going beyond the egg refrigeration rule, the FDA proposed measures to prevent S. enteritidis contamination of shell eggs during egg production. Salmonella, Campylobacter, and E. coli O157:H7, more so than other pathogens, are of significant concern in beef and poultry processing. Listeria monocytogenes, ubiquitous in the environment, has caused several large outbreaks of foodborne illness linked to luncheon meats and hot dogs. Contamination of these products is generally thought to occur post-processing. Listeria monocytogenes can be found in a variety of foods; however, many outbreaks have been associated with ready-to-eat foods. In a continuing effort to prevent L. monocytogenes illness and control this pathogen, the FDA’s Center for Food Safety and Applied Nutrition (CFSAN) and the CDC developed the Listeria Action Plan (http://www.foodsafety.gov/~dms/lmr2plan.html). Six areas for action have been identified at the government, processor, and consumer levels to reduce significantly the risk of illness and death caused by L. monocytogenes in ready-to-eat foods. The FDA is also reexamining the U.S. regulatory policy on L. monocytogenes in food. A proposal has been put forth to eliminate the zero tolerance policy for food products that do not support the growth of L. monocytogenes. Clearly, no single measure can prevent contamination of animal products with microorganisms potentially hazardous to human health. In the United States, government programs are in place, guidance plans have been developed for industry, and consumer education information is available to guide the public in the proper handling of animal products. Such strategies are also in use to ensure the safety of fresh fruits and vegetables. The microbial safety of fresh fruits and vegetables is of global concern with respect to human health (WHO, 1998). In the United States the number of out-breaks of human illness associated with the consumption of fresh produce has increased in recent years (Beuchat, 2002; Sivapalasingam et al., 2004). This has been attributed to a variety of factors, including increased consumption, changes in agronomic and harvesting practices, and increased importation (Beuchat, 2002). The increase in cases of foodborne illness linked to consumption of fresh fruits and vegetables has spurred research addressing the preharvest interactions between foodborne pathogens and growing plants. Recent studies by the USDA’s Economic Research Service and by the FDA’s CFSAN addressed issues of importation and contamination of imported produce (Jerardo, 2003; http://www.cfsan.fda.gov/~dms/prodsur6.html; http://www.cfsan.fda.gov/~dms/prodsur10.html). The percentage of fruits and vegetables that were imported into the country more than doubled from 1985 to 2001. Import of fresh fruits went from 9 percent to 23 percent and for vegetables from

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Food Safety and Foodborne Disease Surveillance Systems: Proceedings of An Iranian-American Workshop 8 percent to 17 percent (http://www.ers.usda.gov/publications/fau/july03/fau7901/fau7901.pdf). During the 1990s, at least 12 percent of foodborne illness outbreaks were linked to fresh produce items. An FDA survey of domestic produce indicated that approximately 1 percent (12 of 1028) of samples were positive for target foodborne pathogens (http://www.cfsan.fda.gov/~dms/prodsur10.html). Approximately 2.6 percent, 1.6 percent, and 1.8 percent of the cantaloupe, cilantro, and lettuce, respectively, were contaminated with Salmonella. In a survey of imported produce > 4 percent (44 of 1003) of samples were positive for either Salmonella (35 or 80 percent) or Shigella (9 or 20 percent) (http://www.cfsan.fda.gov/~dms/prodsur6.html). Numerous avenues exist during the production, harvesting, transport, and marketing of fresh produce for the introduction of pathogens (Beuchat, 2002). Contaminated manure, irrigation water, wash water, equipment, and farm workers are all potential vectors for the transmission of pathogens to fresh fruits and vegetables (Beuchat, 2002). A recent expert report from the Institute of Food Technologists (IFT) stated that “the complexity of the pre-harvest, harvest, and post-harvest environments makes it impossible to control all potential sources of microbial contamination” (IFT, 2002). The microbiological quality of water used for the irrigation and the washing and rinsing of vegetables post-harvest may be the single largest factor in contaminating produce. The USDA’s National Agricultural Statistics Service classifies irrigation methodologies into four categories: sprinkler systems, gravity-flow systems, drip or trickle methods, and subirrigation (USDA, 1998). Sprinkler systems apply water to crops from overhead pipes that are towed into position. Water droplets fall onto the edible portions of the plants as well as onto the soil surface. If the water is contaminated with a pathogen, the edible portion of the plant and the surrounding soil will likely also become contaminated. The advantage associated with sprinkler systems is the potential for more exact water management than with surface irrigation. The remaining three irrigation techniques all involve the direct application of water onto the soil surface by a series of levees, furrows, and underground tubing. Here and throughout this paper these methods are collectively referred to as surface irrigation. With surface irrigation, water contacts primarily the roots of the growing plants. Data from the most recent census (1998) indicated that approximately 50 million acres of farmland were irrigated annually in the United States (USDA, 1998). Of that, 22.9 million acres were irrigated using sprinkler systems and the remainder by surface irrigation. For lettuce specifically, 58 percent of the annual harvest was sprinkler irrigated (USDA, 1998). Studies show that Salmonella and E. coli O157:H7 can survive for extended periods (> 40 days) in well, river, and lake water (Moore et al., 2003; Rice et al., 1999; Wang and Doyle, 1998). Therefore, a very real possibility exists for the contamination of crops in the field through exposure to contaminated irrigation water.

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Food Safety and Foodborne Disease Surveillance Systems: Proceedings of An Iranian-American Workshop At present, chlorine at a concentration of 50-200 ppm is the primary post-harvest sanitizing agent in routine use for fresh produce (Beuchat, 1998); however, this level of chlorine has repeatedly been demonstrated to be ineffective at eliminating pathogens from fruits and vegetables (Beuchat, 2002; Weissinger et al., 2000). Indeed, chlorine is often added to the wash water to reduce the microbial load of the water, not necessarily to kill the specific pathogens that contaminate the produce. While extremely effective against E. coli O157:H7 in aqueous systems (Rice et al., 1999), the efficacy of chlorine is greatly reduced on raw fruits and vegetables. Beuchat et al. (1998) stated that the loss of activity likely occurs when chlorine interacts with organic material such as plant tissues. Numerous other sanitizers including ozone have been examined for use on fresh produce (Koseki et al., 2001), electrolyzed water (Kim et al., 2003), hydrogen peroxide (Lin et al., 2002), lactic acid (Lin et al., 2002), and chlorine dioxide (Han et al., 2000). Under the conditions studied and commercial practices, sanitizing agents are generally not able to reduce by more than 1 or 2 log10 CFU the levels of pathogens on fresh produce (Beuchat et al., 1998). Although other sanitizing agents such as chlorine dioxide and ozonated water are available, chlorine remains the chemical sanitizer most widely used by the produce industry. The efficacy of sanitizers on fresh produce depends largely on the target pathogen’s accessibility. That foodborne pathogens can infiltrate plant tissues is of grave concern since microorganisms present within plants are protected from the actions of surface decontamination practices. Escherichia coli O157:H7 has been shown to localize preferentially on cut edges of lettuce leaves as opposed to intact leaf surfaces (Takeuchi and Frank, 2000). Seo and Frank (1999) demonstrated that cells of E. coli O157:H7 were able to penetrate the interior of cut tissue, becoming entrapped 20-100 μm below the surface. Cells present at these subsurface locations were protected from inactivation with chlorine (Burnett and Beuchat, 2002). The uptake of human pathogens by the root systems of growing crops has also been investigated (Guo et al., 2002; Solomon et al., 2002; Wachtel et al., 2002). The reported uptake of E. coli O157:H7 by the roots of growing lettuce plants (Solomon et al., 2002; Wachtel et al., 2002) and Salmonella by hydroponic tomato plants (Guo et al., 2002) has led to the hypothesis that foodborne pathogens may exist as endophytes within growing plants. It is most likely that internalized bacteria are protected from sanitation by virtue of their inaccessibility. Harvesting practices and equipment can have a significant impact on the microbiology of fresh produce. Approximately 90 percent of fruits and vegetables are harvested by hand (USDA, 2001). Farm workers may transfer pathogens from their hands to the crop or from crop to crop during the harvesting process. The tools used for harvesting (e.g., knives and machetes) and containers used for storage and transport (bins, buckets, and trailers) should be properly washed and

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Food Safety and Foodborne Disease Surveillance Systems: Proceedings of An Iranian-American Workshop sanitized; however, reports indicate that washing and sanitizing, respectively, are done only about 75 percent and 30 percent of the time (USDA, 2001). A relatively new segment of the produce industry, “Fresh Cut,” has emerged in the last 15 years in the United States. Fresh-cut products have been physically altered from the original form, but remain in a fresh state. Products include, for example, salad mixes, sliced or diced tomatoes, and papaya halves. Some processors have moved the early stages of processing lettuce to the field. For example, heads of lettuce are cut at their stems, exterior leaves and core are removed, and the heads are immersed in wash water containing up to 200 ppm chlorine. The lettuce heads are then loaded by conveyor belt into bins lined with a plastic bag and cooled within two hours. There is concern that bringing processing onto the farm could increase the likelihood for microbial contamination. The USDA and the FDA have developed guidelines to minimize foodborne illness associated with fresh produce consumption (http://vmcfsan.fda.gov/~dms, http://www.foodsafety.gov/~dms/prodplan.html). These guidelines include the implementation of Good Agricultural Practices (GAPs), Good Manufacturing Practices (GMPs), and HACCP systems. GAPs encompass irrigation water quality, manure handling, equipment cleaning, and worker education. Other areas being addressed focus on increased communication among growers, packers, and consumers, and increased support of research relevant to fresh produce. Microbial food safety issues with fresh fruits and vegetables will likely always exist since the products are consumed raw; however, contamination can be minimized through comprehensive control strategies from the farm to the table. GAPs must be coupled with GMP and HACCP programs at the post-harvest stage to limit contamination of a product with foodborne pathogens. Such control practices must be implemented not only in the United States but also in countries from which the fresh produce has been imported. Safety of the food supply throughout the world is a major concern as new pathogens emerge and known pathogens reemerge. The foodborne pathogens E. coli O157:H7 and Shigella present significant problems for the food industry and the consumer in part because of their ability to survive under a broad range of conditions. Although these pathogens traditionally have been linked to animal products (eggs, poultry, beef, and dairy products), more recent outbreaks have been associated with water (well and municipal), produce, and processed foods that likely were cross-contaminated. Characterization of these target pathogens has also demonstrated that they are often resistant to one or more antibiotics (Aarestrup and Wegener 1999; Bower and Daeschel, 1999; Bryan et al., 2004). Transmission of pathogens to food occurs at various levels: in the field; during harvesting, processing, and shipping; or in the home. Routes of contamination include water used to irrigate fields, contaminated feed, colonized animals, cross-contamination from fecal matter, the use of improperly composted manure, improper sanitation of processing equipment, and human handling (Beuchat and Ryu, 1997; Wang et al., 1996). Methods employed to enhance the

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Food Safety and Foodborne Disease Surveillance Systems: Proceedings of An Iranian-American Workshop safety of food along the production and processing path should focus not just on slowing or preventing the growth of pathogens but also on eliminating them. Such methods include the use of antibiotics on the farm, sanitizers in the processing plant to prevent cross-contamination, the use of preservatives in foods to prevent and retard growth, and various processes, including pasteurization, to eliminate pathogens. Antibiotics are used in plant and fruit production for disease control and in animal agriculture for therapy, prophylaxis, and growth promotion (Gustafson and Bowen, 1997). A wide range of antibiotics is used (-lactams, sulfonamides, and macrolides) in animal agriculture and, depending on the type of animal (dairy cattle, beef cattle, sheep, poultry, or fish), the target may be treated individually or as a group (herd or flock). Reports indicate that a greater percentage of E. coli O157:H7 and Shigella isolates and other pathogens are antibiotic resistant today compared with 10 to 15 years ago (Sahm et al., 2001; Tollefson and Miller, 2000; Van den Bogaard and Stobberingh, 1999), with many strains exhibiting multiple antibiotic resistance (Kim et al., 1994; Mevius et al., 1999). Antibiotic use on the farm has come under increased scrutiny in light of an increase in the emergence of antibiotic-resistant pathogens. Broad-spectrum antibiotics are typically used for livestock at subtherapeutic levels to promote feed efficiency and growth as well as to control disease (Gustafson and Bowen, 1997). An increase in pathogens resistant to antimicrobials, including E. coli O157:H7 and Shigella, may contribute to the higher prevalence of such resistant bacteria in commensal flora and vice versa. Widespread use of antimicrobials in commercial farming may result in the release of antimicrobial agents into the environment, subsequently causing the emergence of resistant commensal bacteria. Antibiotics excreted by farm animals or incorporated into feed or drinking water can ultimately be dispersed into the environment through the fertilization and irrigation of fields. Often farm wastes (manure, bedding, and feed) are collected in lagoons and pit systems and spread or sprayed onto fields. A range of micro-organisms—including Staphylococcus aureus, nongroupable streptococci, enterobacter, enterococci, and E. coli—isolated from farm workers were significantly more resistant to antibiotics than when isolated from other individuals (Aubry-Damon et al., 2004). Resistant bacteria present on food crops intended for human consumption may prove to be a major route of infection. Enterobacteriaceae are not only found in abundance in the environment but are pathogens and commensals of the human gastrointestinal tract. A Finnish study investigated the potential for raw vegetables to serve as a source of resistant strains of Enterobacteriaceae (Osterblad et al., 1999). The researchers concluded that bacteria from vegetables were not responsible for the high prevalence of resistant Enterobacteriaceae in fecal flora in Finland. Transfer of antibiotic-resistant determinants may occur in vivo between enteric microorganisms. Gene transfer between pathogens is not a new concern and

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Food Safety and Foodborne Disease Surveillance Systems: Proceedings of An Iranian-American Workshop has been reported in both humans and animals. Interspecies gene transfer in vivo occurred in association with an outbreak of shigellosis in 1983 (Tauxe et al., 1989). The Shigella isolate associated with this outbreak carried a plasmid that encoded resistance to ampicillin, carbenicillin, streptomycin, sulfisoxazole, tetracycline, and trimethoprim/sulfamethoxazole; this was identical to the antimicrobial resistance of an E. coli isolated from a case patient’s urinary tract infection that had occurred prior to the onset of shigellosis. Others have investigated the potential for transfer of an apramycin-resistant plasmid from E. coli to S. typhimurium in calves (Hunter et al., 1992). E. coli O157:H7 strains initially associated with human illness were susceptible to most antibiotics used against Gram-negative pathogens. During the last two decades the antibiotic susceptibility profile of E. coli O157:H7 has changed drastically. Only 2 of 200 strains of E. coli O157:H7 collected by the CDC between 1983 and 1985 were resistant to antibiotics (Bopp et al., 1987). Subsequent screening of 125 E. coli O157:H7 (n = 118) and O157:NM (n = 7) revealed that 24 percent were resistant to at least one antibiotic and 19 percent were resistant to three or more antibiotics (Meng et. al., 1998). In a longitudinal study of beef cattle feedlots, E. coli O157:H7 isolates were resistant to six of the eight antibiotics that are used to treat E. coli infections in food animals (Galland et. al., 2001). Perhaps surprisingly, less than one-half of the isolates were resistant to tetracycline, one of the most extensively used antibiotics on feedlots. Compared with other foodborne pathogens or with other E. coli isolates, the level of antibiotic resistance of E. coli O157:H7 is generally low and basically limited to tetracycline, streptomycin, and sulfamethoxazole. Shigella, although associated with foodborne illness, accounts for only a fraction of the total cases of foodborne illnesses that occur in the United States (Mead et al., 1999; Shiferaw et al., 2004). A large outbreak in 1987 was likely the result of transmission by food, water, and person to person (Wharton et al., 1990). The outbreak strain was resistant to ampicillin, tetracycline, and trimethoprim-sulfamethoxazole. Contamination of crops with Shigella through application of contaminated manure to fields or contaminated irrigation water may occur. Fresh raw agricultural ingredients associated with prepared foods are also often implicated as the source of Shigella (CDC, 1999). In 2000 a nationwide outbreak of shigellosis involving 406 persons was traced to a commercially prepared five-layer dip (Kimura et al., 2004). The outbreak was probably the result of a food handler shedding the pathogen since the guacamole and salsa used were also sold as stand-alone products, and in that context were not linked to illnesses. The potential for the spread of antibiotic-resistant Shigella from one country to another should not be ignored. A recent study from South Asia indicates that all Shigella isolates evaluated were resistant to ampicillin, tetracycline, nalidixic acid, and ciprofloxacin (Bhattacharya et al., 2003). Perhaps most alarming is that small outbreaks of shigellosis due to ciprofloxacin-resistant strains have been

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Food Safety and Foodborne Disease Surveillance Systems: Proceedings of An Iranian-American Workshop detected (Bhattacharya et al., 2003). These reports underscore the potential role that food handlers and agricultural production practices in one country may have on the occurrence of Shigella that are multiply resistant to antimicrobials in countries with which they trade. Indeed, a recent study conducted in Karaj, Iran, indicated that approximately 91 percent and 88 percent, respectively, of Shigella isolates were resistant to one or more antimicrobial agents and 88 percent were multidrug resistant (MoezArdalan et al., 2003). The issue of vancomycin-resistant Enterococcus faecium (VREF) is worrisome. Reservoirs for VREF include food and other sources, such as cattle, swine, poultry, minced pork or beef, and pet food. The concern stems from the use of streptogramin antibiotics as growth promoters and therapeutic agents in farm animals, and the use of streptogramins to treat patients with VREF infections. Streptogramin-resistant organisms are now common in the food supply, although factors associated with foodborne transmission need to be clarified (McDonald et al., 2001). Sampling of chicken carcasses revealed that 237 of 407 carcasses were positive for streptogramins-resistant E. faecium (McDonald et al., 2001). Risk modeling recently suggested that banning the use of virginiamycin in chickens would have little impact on human morbidity and mortality (Cox and Popken, 2004). However, carriage of resistance by commensal bacteria and transfer of resistance is unpredictable; therefore the effects of agricultural use of antibiotics on human health remains uncertain (Smith et al., 2005). The continued safety of the U.S. food supply requires a proactive approach. Science-based means must be used to establish food safety guidance and regulations. Greater funding must be made available to support needed research and the development of expert panels to aid in establishing food safety objectives. Food safety objectives may focus on anything from the use of antibiotics in agriculture to distribution of resources by public health organizations. Since there is no all-encompassing solution to foodborne disease, establishing objectives will permit the allocation of limited resources that have the greatest impact on food safety. Human foodborne disease surveillance systems, use of microbiological risk assessment, and statistical process control are scientific tools that regulators can use when developing compliance with regulations. Programs such as GAPs, GMPs, and HACCP must be further developed to prevent contamination of food during its journey from the farm to the table. International coordination is required to develop effective food safety measures. In a global society and marketplace it is possible for people, food, and pathogens to circle the world in a single day. To combat the spread of pathogens, greater consumer participation is required. For example, practicing personal hygiene (e.g., hand washing) and proper food handling will reduce the spread of foodborne pathogens and help to control or kill pathogens in foods prior to consumption (i.e., cook the food thoroughly in order to kill potentially harmful bacteria). Food safety will be realized through the melding of science and common sense, ultimately protecting consumers throughout the world.

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Food Safety and Foodborne Disease Surveillance Systems: Proceedings of An Iranian-American Workshop Overview of Safety Issues in Iran for Food Derived from Animals or Plants Dr. M. R. Akbarian HACCP Food Safety Consultant, Iran Veterinary Organization Food security (sufficient and safe food for all individuals) has become a top priority because of the world’s growing population and its limited resources. According to such international organizations as the United Nations’ Food and Agriculture Organization (FAO) and the World Health Organization (WHO), the situation is considered problematic when nearly 25 percent of produced food is destroyed by spoilage, especially degradation by microbial agents, and fails to reach consumers. Apart from safety aspects, spoilage imposes severe economic burdens on many countries and producers. Another aspect concerns the increase in urban populations and decline of rural communities. This development has caused fundamental changes in food consumption patterns, food processing, and even food hazards. Not so long ago, the most important etiological agents of disease from contaminated foods were bacteria, parasites, and viruses. These agents still play major roles in causing consumer health problems, but new hazards—such as veterinary drug residues, pesticides, chemicals like heavy metals, and other environmental contaminants—are as important as the biological factors. According to WHO and FAO studies and reports, illness due to contaminated food is one of the world’s most widespread health problems and an important factor in reduced economic productivity, especially in developing and underdeveloped countries. When we define food security, it is for all people, at all times. We say that there should be access to sufficient, safe, and nutritious food to meet dietary needs and satisfy food preferences for an active and healthy life. Actually, this makes food safety a basic human right. It must, therefore, be given a higher priority by all governments.

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Food Safety and Foodborne Disease Surveillance Systems: Proceedings of An Iranian-American Workshop Currently, millions of people worldwide are suffering from diseases caused by contaminated food, which inflicts heavy social and economic burdens. The incidence and types of foodborne disease differ in different parts of the world. In developed countries many such diseases do not exist at all or have been largely prevented by food safety education, higher standards of hygiene, improved water supplies and sanitation, and better technologies for producing safe food. Nevertheless, significant portions of the population in industrial countries are affected by foodborne diseases despite the demanding standards and advanced measures. As mentioned above, food safety is viewed as an essential public health issue of increasing importance. Therefore, for the well-being of society all governmental and nongovernmental agencies should assume responsibility for the production of safe food. FOOD SAFETY SYSTEM IN IRAN Food production, processing, marketing, and distribution systems in Iran are complex. They also are fragmented and involve a large number of intermediaries between the producer and the consumer. From producing and processing points of view we have in Iran both traditional means and industrial methods; the differences between these two raise problems when trying to apply the new concepts of food safety. Responsibility for food safety is shared by Iran’s government, industries, and consumers. At the government level three ministries provide consumer protection: the Ministry of Health and Medical Education, the Ministry of Jihad-e-Agriculture, and the Ministry of Industry. For all three there are legislative acts delineating their responsibilities. Here I will mention only the safety issues concerning foods of animal origin for which the IVO (Iran Veterinary Organization) is responsible. The IVO works under the auspices of the Ministry of Jihad-e-Agriculture, and the basic law for its duties is the Veterinary Organization Act ratified on June 14, 1971. This act includes 21 articles and 1 amendment. The purposes of establishing this organization were to provide for the good health of animals, for safe products of animal origin, and to prevent and control animal diseases and zoonoses. The IVO has several basic principles with which it seeks to attain these goals, achieve optimum consumer protection, and ensure food safety. INTEGRATED FARM-TO-TABLE CONCEPT To achieve optimum consumer protection, it is essential that safety be em-bodied in food products from production through consumption. This calls for an integrated farm-to-table approach in which the producer, processor, transporter, vendor, and consumer all play vital roles. To ensure adequate consumer protection and to effectively control, reduce,

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Food Safety and Foodborne Disease Surveillance Systems: Proceedings of An Iranian-American Workshop or minimize food safety risks, a preventive approach was developed and appropriate preventive measures were introduced into all stages from farm to table. Prevention, control at the source, and identification of unsuitable products at an early stage make better scientific and economic sense compared to the traditional approach to food control, which relied mainly on final product inspection and testing. The IVO started these new activities a decade ago and based them on the principles of good animal husbandry practices, animal biosecurity measures, good hygiene practices for animal farms, and application of good hygiene practices (GHPs) and Hazard Analysis and Critical Control Point (HACCP) regulations to the production of raw foods of animal origin. All this was done in conformity with World Organization for Animal Health (OIE), Codex Alimentarius, and European Commission guidelines. At the moment, this new approach to food safety is being applied comprehensively to fishery products. In 1998 Iran was placed on the list of countries approved for exporting fish and fishery products to European nations. For other raw foods of animal origin, such as meat, poultry products, and milk, the IVO started this new approach to food safety four years ago. Currently, prerequisite HACCP programs are applied in all slaughter houses and at all processing and packaging sites. In the near future these activities will introduce full HACCP systems to these sites. In brief, the important activities performed by the IVO are: Hygienic control of the infrastructure and site aspects of animal farms and aquaculture centers. Hygienic control of live animals at farms and screening to control or eradicate major diseases according to OIE guidelines. Monitoring of veterinary drug residues and supervision of the use of these drugs to prevent unauthorized applications and bar unauthorized materials. The IVO also supervises the interval between medication withdrawal and slaughter. Hygienic control of establishments producing animal feed in terms of infrastructure, site, and application of good manufacturing practice (GMP) and GHP principles. Safety and hygienic control of animal feed with respect to biological, chemical, and physical hazards in order to prevent these hazards from impacting consumers. Supervision and hygienic control of the means for transporting animals and animal products in order to prevent illegal traffic. The IVO has also installed quarantine check-points across the country and at the borders. Hygienic control and supervision of slaughter houses, processing sites, and packaging establishments for raw animal products. The IVO has placed health inspectors in these establishments to monitor all stages of production and processing.

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Food Safety and Foodborne Disease Surveillance Systems: Proceedings of An Iranian-American Workshop All these establishments must be designed and built according to GMP and GHP prescriptions; HACCP systems have been fully implemented for fishery products to protect consumers against hazards. Hygienic control and supervision of food of animal origin at retail markets. Conducting of regular training courses for IVO inspectors and related personnel, especially in HACCP, GMP, GHP, and auditing skills. Application of quality assurance systems, such as ISO 17025, in laboratories that test raw foods of animal origin as well as the establishment of a reference laboratory to control veterinary drug residues, heavy metals, and other contaminants in animal products. Participation in international meetings, such as the Codex Alimentarius committees. Cooperation with the FAO, with this organization providing technical and logistical support for a project to control veterinary drug residues in food of animal origin. REFERENCES CAC (Codex Alimentarius Commission). 2003. Food Hygiene Basic Texts. Codex Alimentarius Commission.Third Edition. Rome: FAO Publication. FAO (Food and Agriculture Organization). 1996. Declaration on World Food Security. Report of the World Food Summit. Rome: FAO Publication. FAO/WHO (Food and Agriculture Organization/World Health Organization). 1992. World Declaration and Plan of Action for Nutrition. Final Report of International Conference on Nutrition. Rome: FAO Publication. FAO/WHO. 2002. Global Forum of Food Safety Regulators. Morocco, 28-30 Jan. Rome: FAO Publication. WHO/SDE/PHE/FOS. 1999. Food Safety: An Essential Public health Issue for the New Millennium. Geneva: World Health Organization.

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Food Safety and Foodborne Disease Surveillance Systems: Proceedings of An Iranian-American Workshop The Role of the Institute of Standards and Industrial Research of Iran in Food Safety M. H. Sh. Hassanpour Head of Food Department, Institute of Standards and Industrial Research of Iran The concept of food standards in Iran is historic, as old documents attest. One document published about two centuries ago as Makhzan-O-L Advieh, written by Mohammad Hossein Aghili Khorasani, offers recommendations to those who purchase spices and condiments. What are called jayyed mokhtar or best characteristics can be translated as standards today. On the other hand, the Holy Koran emphasizes that Moslems ought to choose or avoid certain foods and divides all foods into halal (permitted for use) and haram (not permitted). This was the first food rule or set of food standards for Moslems. Food safety and food quality terminology may sometimes be confusing. Food safety is concerned with all aspects, whether immediate or long-term, that may make food unsafe for the consumer. Therefore, safe foods or foodstuffs contain nothing that is hazardous or injurious. Food quality includes all other attributes that influence a product’s value. This includes such negative attributes as spoilage, contamination with nontoxic and noninfectious filth, discoloration, and odors and such positive attributes as freshness, appetizing color and flavor, pleasing texture, and favorable origins, as well as the results of processing methods that make food more edible. This distinction between safety and quality has implications for public policy and influences the nature and content of the food control system suited to meet predetermined national objectives. Therefore, food control is defined as follows: A mandatory regulatory activity of enforcement by national or local authorities to provide consumer protection and ensure that all foods during production, handling, storage, processing, and distribution are safe, wholesome, and fit for human consumption; that they conform to quality and safety requirements; and that they are honestly and accurately labeled as prescribed by law.

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Food Safety and Foodborne Disease Surveillance Systems: Proceedings of An Iranian-American Workshop ELEMENTS OF FOOD SAFETY While the components and priorities of food safety may vary from country to country, most systems will typically comprise the following components: Food laws and regulations; Food control management; Inspection, surveillance, and sampling; Laboratory services for food monitoring and epidemiological data; and Information, education, communication, and training. FOOD SAFETY IN IRAN Responsibility of food control in Iran, like most other countries, is shared by different ministries and agencies. These include: Ministry of Health, Treatment, and Medical Education; Institute of Standards and Industrial Research of Iran (ISIRI); and Ministry of Jihad-e-Agriculture (the previous Ministry of Agriculture). THE ROLE OF THE ISIRI According to Iranian law, the ISIRI has the sole authority for the determination, compilation, and publication of all official national standards in Iran. It is also the only authorized body for supervising the implementation of standards and regulations and directing research in related fields; however, pharmaceutical standards and supervision of their implementation is the duty of the Ministry of Health. PREPARATION OF NATIONAL STANDARDS The ISIRI has issued more than 7000 national standards in all areas of industry, over 2000 of which (28 percent) are for food products. For preparing food standards and regulations at the national level, the technical committees try to apply international standards (ISO), Codex Alimentarius, national data, and standards of other countries (especially when safety parameters have to be adapted to national values and local considerations). Technical committees cover all authorized agencies, including nongovernmental organizations, academic groups, the private sector, manufacturers, and consumer protection associations. These food standards (2000 standards) are classified into the following three groups: (1) specifications, (2) test methods, and (3) codes of hygienic practice. All food standards include the following quality and safety factors: physical,

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Food Safety and Foodborne Disease Surveillance Systems: Proceedings of An Iranian-American Workshop chemical, and microbiological specifications; contaminants (e.g., heavy metals); toxins such as mycotoxin; additives; packaging; labeling; and sampling. IMPLEMENTATION OF NATIONAL STANDARDS With approval of the Supreme Council of Standards, the ISIRI may declare the implementation of standards for goods (or components) and codes of practice as compulsory standards in regard to safety, public health protection, product quality assurance, consumer protection, and other welfare or economic considerations. The ISIRI may determine the time limits for implementation, which must be at least three months. More than 100 items in the food standards are compulsory. These cover all domestic food production and imported and exported foods. Whenever the implementation of standards is declared compulsory for certain goods, within determined time limits, production, storage, distribution, and sale of such goods that have a lower quality than the standard and are not branded with the ISIRI mark are forbidden. The infringer may be sent to applicable courts. The ISIRI is responsible for implementation of compulsory national standards. To receive the ISIRI mark for meeting compulsory standards, all producers must establish acceptable good manufacturing practice (GMP) and quality monitor systems and be found at least three times to conform fully with the quality specifications adopted for a commodity and also to the related national standards. INSPECTION The administration of food laws and their implementation requires a qualified, trained, efficient, and honest food inspection service. This service has an important role in food safety and ensures consumer confidence in imported and exported foods and in the ISIRI mark, which indicates adequate quality for domestic foods. ISIRI inspectors and experts are authorized to enter production sites, as well as sites of packaging, storage, supply, sale of goods, and rendering service sites—all places covered by compulsory standards—in order to inspect and take samples. LABORATORY SERVICES Laboratories are essential components of a food control system. The establishment of laboratories requires considerable investment for they are expensive to maintain and operate. Therefore, careful planning is necessary to achieve optimum results. ISIRI laboratories are recognized as nationally accredited labs for the deter-

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Food Safety and Foodborne Disease Surveillance Systems: Proceedings of An Iranian-American Workshop mination of product characteristics, for adherence to relevant standards, and for the calibration of measuring instruments. The ISIRI has 28 branches throughout the country. These execute ISIRI objectives and policies and protect consumers. They have adequate facilities for physical, microbiological, and chemical analyses and they use accredited laboratories for testing and monitoring. All methods that are used are verified and based on certified references such as ISO, Codex Alimentarius, Association of Analytic Communities International, and American Oil Chemists’ Society. To improve laboratory performance and ensure the reliability, accuracy, and repeatability of results, ISIRI laboratories participate in proficiency testing administered by international assurance programs. This is especially important for mycotoxin analysis and microbiological determination. INFORMATION, EDUCATION, COMMUNICATION, AND TRAINING An increasingly important role for food control systems is the delivery of information, education, and advice to all stakeholders across the farm-to-table spectrum. Such activities provide an important means of building food control expertise and skills in all interested parties, and thereby they have an essential preventive function. The ISIRI has a scheduled program for training of all stakeholders to improve their knowledge of food safety. This program consists of training university students and quality control officers in factories, giving television interviews, publishing educational pamphlets, conducting classes in laboratory analysis, and test result reporting. NATIONAL STANDARDS FOR FOOD SAFETY MANAGEMENT The shift in focus by quality control systems from finished products to a food’s entire farm-to-table span has opened a new horizon for food control systems. In accordance with this new concept, international organizations designed and recommended quality assurance (QA) systems such as food safety management and Hazard Analysis and Critical Control Point (HACCP) to local and national authorities in Iran. The first national HACCP guideline and the first national GMP text were prepared and published by the ISIRI. They were based on Codex Alimentarius, 1997, and were subsequently revised to conform to the latest Codex Alimentarius standards. Many codes of hygienic practice for different food commodities were prepared in accordance with Codex Alimentarius, scientific evidence, and national standards. To promote QA systems (such as HACCP) in the country, an Iranian National Committee for HACCP has been formed in the Ministry of Health. The committee’s aims are the following:

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Food Safety and Foodborne Disease Surveillance Systems: Proceedings of An Iranian-American Workshop promote QA systems for related agencies; encourage the producers to establish HACCP in their plants; coordinate such activities throughout the country; train and educate staff at different levels; and compile educational materials based on national standards and guidelines. GLOBAL CONSIDERATIONS The expanding world economy, food trade liberalization, growing consumer demands, advances in food science and technology, improvements in transport and communication, international trade in fresh and processed food, the increase in food varieties, and the requirements of food safety all mandate a linking of ministries and related agencies; this linking should be on both a national and an international scale. The Iranian Coordinating Council for Codex Alimentarius was established in 1980 and reorganized according to a new plan in 1998. The council has a section called Iranian National Codex (Alimentarius) Committee (NCC) that covers 21 technical committees (TCs) that include all stakeholders. It is note-worthy that ISIRI is the only contact point for the World Health Organization/ Food and Agriculture Organization Codex Alimentarius Commission in Iran. The main goals of NCC are as follows: Participate in the preparation of international standards by considering them national priorities and opportunities; Participate actively in Codex Alimentarius meetings; Elevate the level of national standards by basing them on international levels, especially in safety and health requirements; and Combine scientific and technical information for informing producers, consumers, and all stakeholders. The ISIRI is also a member of the ISO and has established a national TC34 counterpart committee so that authorized local organizations and stakeholders can participate in ISO activities. CONCLUSION Since food safety is pivotal to health and development, it is mandatory to coordinate all activities at the national level. Considering the national situation in Iran, all authorized organizations and agencies must carry out their duties in accordance with the law and forward all data to designated departments for proper management of the information.

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Food Safety and Foodborne Disease Surveillance Systems: Proceedings of An Iranian-American Workshop Considering the importance of food safety management systems, such as HACCP, it is necessary to expand the establishment of such systems throughout the country. In food safety fields promotion of public awareness is very important and it should be developed by organizing special programs that will involve all related organizations.

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Food Safety and Foodborne Disease Surveillance Systems: Proceedings of An Iranian-American Workshop Discussion Dr. Mohammadreza Razailashkajani Research Center for Gastroenterology and Liver Disease Shaheed Beheshti University of Medical Sciences Panel: Dr. Jackson, Dr. Matthews, Dr. Montes Niño, and Dr. Jamdar Dr. Jackson first challenged the audience with the question, “What is food safety?” He asked the question in relation to the immune status of a population. Vibrio in seafood became a focus of the discussion. A scientist from the Pasteur Institute of Iran pointed to the role of food transportation as a cause of Vibrio contamination. He also mentioned anaerobic bacteria as important contaminants of seafood in Iran. Another challenge came from Dr. Matthews. It concerned the routes by which Salmonella may contaminate vegetables and fresh produce. He explained the role of irrigation water, manure, and the low level of hygiene among farm workers in contributing to the problem of contaminated produce imported into the United States. Enterococcus faecalis resistance to vancomycin and the ways Staphylococcus aureus could contaminate food were the next topics. Dr. Salmanzadeh, a microbiologist from the Research Center for Gastroenterology and Liver Disease, raised a question about the methods used in the United States to estimate incidence of Shiga-toxin-producing Escherichia coli. The safety of food produced using bioengineering and the ways of implementing food safety measures in the United States were the next topics. Dr. Matthews answered the final questions, which addressed the role of chlorine as a disinfectant in slaughterhouses, future alternatives, and the ways that the government of the United States controls imported foods.