FOOD SAFETY AND FOODBORNE DISEASE SURVEILLANCE SYSTEMS

PROCEEDINGS OF AN IRANIAN-AMERICAN WORKSHOP

Edited by Glenn Schweitzer, Mohammad Reza Zali, and George Jackson

Office for Central Europe and Eurasia Policy and Global Affairs

NATIONAL RESEARCH COUNCIL OF THE NATIONAL ACADEMIES

in cooperation with

Research Center for Gastroenterology and Liver Disease

Shaheed Beheshti University of Medical Sciences, Tehran

World Health Organization

Food and Agriculture Organization

THE NATIONAL ACADEMIES PRESS
Washington, D.C.
www.nap.edu



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Food Safety and Foodborne Disease Surveillance Systems: Proceedings of An Iranian-American Workshop FOOD SAFETY AND FOODBORNE DISEASE SURVEILLANCE SYSTEMS PROCEEDINGS OF AN IRANIAN-AMERICAN WORKSHOP Edited by Glenn Schweitzer, Mohammad Reza Zali, and George Jackson Office for Central Europe and Eurasia Policy and Global Affairs NATIONAL RESEARCH COUNCIL OF THE NATIONAL ACADEMIES in cooperation with Research Center for Gastroenterology and Liver Disease Shaheed Beheshti University of Medical Sciences, Tehran World Health Organization Food and Agriculture Organization THE NATIONAL ACADEMIES PRESS Washington, D.C. www.nap.edu

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Food Safety and Foodborne Disease Surveillance Systems: Proceedings of An Iranian-American Workshop THE NATIONAL ACADEMIES PRESS 500 Fifth Street, N.W. Washington, DC 20001 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance. This study was supported by the National Research Council. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the authors and do not necessarily reflect the views of the organizations or agencies that provided support for the project. International Standard Book Number 0-309-10033-X One copy of this report per request is available from the Office for Central Europe and Eurasia, National Research Council, 500 Fifth Street, N.W., Washington, DC 20001; (202) 334-2644; Fax (202) 334-2614 Additional copies of this report are available from the National Academies Press, 500 Fifth Street, N.W., Lockbox 285, Washington, DC 20055; (800) 624-6242 or (202) 334-3313 (in the Washington metropolitan area); Internet, http://www.nap.edu. Copyright 2006 by the National Academy of Sciences. All rights reserved. Printed in the United States of America

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Food Safety and Foodborne Disease Surveillance Systems: Proceedings of An Iranian-American Workshop THE NATIONAL ACADEMIES Advisers to the Nation on Science, Engineering, and Medicine The National Academy of Sciences is a private, nonprofit, self-perpetuating society of distinguished scholars engaged in scientific and engineering research, dedicated to the furtherance of science and technology and to their use for the general welfare. Upon the authority of the charter granted to it by the Congress in 1863, the Academy has a mandate that requires it to advise the federal government on scientific and technical matters. Dr. Ralph J. Cicerone is president of the National Academy of Sciences. The National Academy of Engineering was established in 1964, under the charter of the National Academy of Sciences, as a parallel organization of outstanding engineers. It is autonomous in its administration and in the selection of its members, sharing with the National Academy of Sciences the responsibility for advising the federal government. The National Academy of Engineering also sponsors engineering programs aimed at meeting national needs, encourages education and research, and recognizes the superior achievements of engineers. Dr. Wm. A. Wulf is president of the National Academy of Engineering. The Institute of Medicine was established in 1970 by the National Academy of Sciences to secure the services of eminent members of appropriate professions in the examination of policy matters pertaining to the health of the public. The Institute acts under the responsibility given to the National Academy of Sciences by its congressional charter to be an adviser to the federal government and, upon its own initiative, to identify issues of medical care, research, and education. Dr. Harvey V. Fineberg is president of the Institute of Medicine. The National Research Council was organized by the National Academy of Sciences in 1916 to associate the broad community of science and technology with the Academy’s purposes of furthering knowledge and advising the federal government. Functioning in accordance with general policies determined by the Academy, the Council has become the principal operating agency of both the National Academy of Sciences and the National Academy of Engineering in providing services to the government, the public, and the scientific and engineering communities. The Council is administered jointly by both Academies and the Institute of Medicine. Dr. Ralph J. Cicerone and Dr. Wm. A. Wulf are chair and vice chair, respectively, of the National Research Council. www.national-academies.org

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Food Safety and Foodborne Disease Surveillance Systems: Proceedings of An Iranian-American Workshop NATIONAL RESEARCH COUNCIL COMMITTEE ON THE U.S.-IRANIAN WORKSHOP ON FOOD SAFETY Michael P. Doyle (chair) Director/Professor, Department of Food Science & Technology University of Georgia William E. Keene Senior Epidemiologist, Acute and Communicable Disease Program Oregon Department of Human Services Mansour Samadpour Assistant Professor of Environmental and Occupational Health Sciences University of Washington NRC STAFF Glenn Schweitzer Director Office for Central Europe and Eurasia Sara Gray Senior Program Associate Office for Central Europe and Eurasia Amy Moore Program Assistant Office for Central Europe and Eurasia

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Food Safety and Foodborne Disease Surveillance Systems: Proceedings of An Iranian-American Workshop Preface and Acknowledgments In October 2004 the Research Center for Gastroenterology and Liver Disease of Shaheed Beheshti University hosted in Tehran an Iranian-American workshop on Food Safety and Surveillance Systems for Foodborne Diseases. The purposes of the workshop were to initiate contacts between Iranian and American specialists, exchange information about relevant activities in the two countries, and set the stage for future cooperation in the field. The participants also identified important aspects of food safety that should be addressed more intensively by both countries, including surveillance, research, international trade, and risk assessment. The framework for the workshop had been developed during a meeting of Iranian and American specialists in June 2003 in Les Treilles, France. The Research Center for Gastroenterology and Liver Diseases selected the Iranian participants in the workshop, and the U.S. Institute of Medicine selected the American participants. Representatives of the World Health Organization and the Food and Agriculture Organization also made brief presentations. Altogether more than 100 specialists participated in the workshop in their personal capacities. The documents developed during and following the workshop reflected their personal views and not the views of their organizations. These proceedings include a number of papers that were presented at the workshop together with summaries of discussions following presentation of the papers. Upon completion of the workshop, the American participants had the opportunity to continue their discussions with counterparts at their institutions and to visit several production, research, and clinical facilities in the Tehran area. The workshop papers and the discussions during the workshop and during

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Food Safety and Foodborne Disease Surveillance Systems: Proceedings of An Iranian-American Workshop the subsequent visits provide a good basis for continuing international cooperation in this field, which is of growing importance to all countries. The specialists and officials that participated in this activity are identified in the appendixes. Their contributions are greatly appreciated. Dr. Mohammad Reza Zali deserves particular recognition for his continuous efforts in ensuring that the activities would be professionally rewarding for the specialists. The contributions of the staffs of the Research Center for Gastroenterology and Liver Disease of Shaheed Beheshti University of Medical Science and of the Food and Nutrition Board of the Institute of Medicine, particularly Ricardo Molins, also deserve recognition. Special appreciation is extended to the Academy of Medical Sciences of Iran and to the National Academies of the United States for their assistance in facilitating the holding of the workshop, and to the National Research Council (NRC), which provided funding for this project. This volume has been reviewed in draft form by individuals chosen for their technical expertise, in accordance with procedures approved by the NRC’s Report Review Committee. The purpose of this independent review is to provide candid and critical comments that will assist the institution in making its published report as sound as possible and to ensure that the report meets institutional standards for quality. The review comments and draft manuscript remain confidential to protect the integrity of the process. We wish to thank the following individuals for their review of selected papers: Kathryn Boor, Cornell University; Michael Doyle, University of Georgia; Jocelyne Rocourt, Pasteur Centre of Cameroon; and Allison Yates, ENVIRON. Although the reviewers listed above have provided constructive comments and suggestions, they were not asked to endorse the content of the individual papers. Responsibility for the final content of the papers rests with the individual authors. -Glenn E. Schweitzer Director, Office for Central Europe and Eurasia National Research Council -George Jackson Microbiologist, Food and Drug Administration (Retired) -Mohammad Reza Zali President, Research Center for Gastroenterology and Liver Disease Shaheed Beheshti University of Medical Sciences

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Food Safety and Foodborne Disease Surveillance Systems: Proceedings of An Iranian-American Workshop Contents DAY 1     Opening Session   1 Morning Session         Overview of Food Safety Issues and of Diseases Arising from Food of Animal and Plant Origin in the United States   5     Overview of Safety Issues in Iran for Food Derived from Animals or Plants   18     The Role of the ISIRI in Food Safety   22     Discussion   28 Afternoon Session         Surveillance for Foodborne and Diarrheal Diseases, Including Outbreak Investigations: An American Perspective   31     Foodborne Disease Investigations, Including Surveillance: A Collaborative Pilot Project   46     Discussion   51

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Food Safety and Foodborne Disease Surveillance Systems: Proceedings of An Iranian-American Workshop DAY 2     Morning Session         Inspection and Investigation: Tools for Detecting Sources of Food Contamination and Preventing Illness Outbreaks   55     Food Monitoring, Investigation, and Inspection Infrastructure in Iran   63     Discussion   68 Afternoon Session         Food Traceability: A Response to Consumers   73     The Role of Risk Analysis in a Science-Based Approach to Food Safety   76     The Hazard Analysis and Critical Control Point System   94     Implementing and Auditing HACCP Systems and Difficulties In Iran   97     The History of Food Safety in Iran   100     Discussion   103 DAY 3         Final Plenary Session: Future Steps and Opportunities   107     Closing Session   110 APPENDIXES     A   Workshop Agenda   113 B   Participant List   117