Health Committee on June 10th, 2010

[Dr. Mark Raizenne, Director General, Centre for Food-borne, Environmental and Zoonotic Infectious Diseases (CFEZID), Public Health Agency of Canada]

Thank you very much.

In doing the consultation on the revisions of the FIORP, it was very clear that, as was mentioned, every province deals with food-borne outbreaks in various ways. In some cases, it's the chief medical officer of health who actually manages everything; and in other places, it's managed very much on the agriculture side and on the health side in separate ways.

It was clearly identified that what we wanted to do with the FIORP was bilaterals. We'd actually do it province by province.

We've already done Ontario. We've had a very good first pass with Ontario.

We actually also did a tabletop exercise with all of the epidemiologists and laboratory leaders in Winnipeg, in May, to see how it would resonate as a collective. The plan is, in the fall, to systematically go to each province, where the province would like us to look at their provincial FIORP process, and then bring everybody together at one point.

[Carolyn Bennett, Liberal, St. Paul's, ON]

Okay. I think it's to bring everybody together, because this clearly was a pan-Canadian outbreak. It was such a large plant that went across the country very quickly, which I think is the concern.

Can you let us know when the pan-Canadian tabletop will take place?

[Dr. Mark Raizenne]

Yes, we will.

[Carolyn Bennett, Liberal, St. Paul's, ON]

Okay.

Again, I just want to go back to Panorama. When will it be there; how quickly?

[Dr. David Butler-Jones]

It's close. Infoway had a process; IBM is the contractor. B.C. was the lead province, working with the other provinces. We're very much involved. We're looking at what is the best way to move it forward at this point, as B.C. moves away from that, and we're doing some work now with the provinces and territories to do it with this, with food-borne.

[The Vice-Chair, Liberal, Joyce Murray]

Thank you very much.

Just as a point of clarification, Dr. Bennett asked for a report of the progress on each of the 57 recommendations, which had been completed and the timeframes for the others. I saw a lot of nods, but I just would like to clarify who's taking responsibility for that request and when it will be available to the committee.

[Carolyn Bennett, Liberal, St. Paul's, ON]

There's also a question on the order paper.

[Dr. David Butler-Jones]

We can certainly take responsibility for our part, and we can relay the request to others.

[The Vice-Chair, Liberal, Joyce Murray]

When can the committee expect that update?

[Dr. David Butler-Jones]

In practical terms, what, a week to 10 days...?

[Dr. Mark Raizenne]

Certainly by the end of the month.

[Dr. David Butler-Jones]

By the end of the month.

[The Vice-Chair, Liberal, Joyce Murray]

Thank you very much.

Dr. Carrie.

[Colin Carrie, Conservative, Oshawa, ON]

Thank you very much, Madam Chair.

Again, I want to thank you all for being here.

I must say, today, after listening to you, I'm very impressed with the action you're taking with the investments the government has made to implement these recommendations. I'm also impressed with how you've improved the communications and working collaboratively. I think all of us here understand from the lessons we've learned how difficult it is with the communications locally, provincially, federally, with industry and with the public, and how difficult it can be sometimes to respect all these different jurisdictional challenges in Canada.

I was wondering if you could take us through the process now with what you've learned.

Dr. Butler-Jones, you made an interesting comment at the beginning. I think you said that over 20,000 Canadians per day can have symptoms of something such as listeriosis, or whatever will come around in the future. If you look at listeria in general, it's very common. Much of this is handled at the local level.

I was wondering if you could walk us through just a little bit of the process of what you've learned and what we've seen in improvements in terms of how to take something that's locally at a doctor's office to, here we go, now we have to take a look at this as a bigger-picture type of spectrum.

[Dr. David Butler-Jones]

Surveillance is going on all the time in the sense that if someone is ill, they go to the hospital or the doctor's office. They may or may not be tested. If they are tested, then that will eventually end up in the lab. If it's one of the organisms we're interested in, then local public health will get a report. If they identify that it's more than just a one-off, all of them will be inspected in the sense of is this a family issue, is it a bigger issue? If you have 30 cases of the same bug, then you get concerned.

Sometimes it's even far less than that. For example, we had half a dozen cases of cryptosporidium, which prompted the boil-water advisory in North Battleford, because where else could it have come from? Then rumours of other people.... Part of it, at the end of the day, is that whether you need a food recall or not, there are also public health interventions in terms of advice, etc., in the beginning.

So we get these samples. In the case of listeria, listeria is ubiquitous in the environment. Most of us don't ever get sick from it, even if we're eating it on our lettuce or whatever. But for vulnerable people, it can be a very nasty disease, as we saw a couple of summers ago. In that case, what happened is that we got lab samples. Ontario recognized that they had a couple more cases than they would expect. We were able through the PulseNet system to identify that we had one strain of this particular bacteria, which meant that it had a common source. We didn't know at the time what the common source was, but it forced us to go looking, and with CFIA to go looking. At the same time, there was a nursing home outbreak with a couple of cases--not dozens, but a couple of cases--that had the same pattern. By tracing what they'd been eating, etc., we were able in fairly short order to identify that it had come from that particular Maple Leaf plant, and to make the connection.

While at the end of the day we had lots of people being ill, and deaths, at the time that we recognized it we'd actually had only a handful of cases, but the recognition was that they were common and they had a common source, so we needed to pursue that. Again, because listeria has such a long incubation period, it meant that even though we had identified it, at that point these were people who actually had eaten it many weeks before so there would be more people. But once you recognize it, you can reduce the risk of anybody else eating it, and as a result reduce ultimately the number of people affected and reduce the number of deaths.

[Colin Carrie, Conservative, Oshawa, ON]

Excellent.

So what are we seeing now with the improvements in communication and collaboration amongst the different levels, local, provincial, and federal? What are you seeing being put into place, and what do you foresee in the not-too-distant future?

[Dr. David Butler-Jones]

In practical terms, I think it will allow us to get the communications more quickly, the recognition of the problem more quickly, and the engagement of other parts of the system more quickly, so that the decisions come more quickly about what else needs to be done.

As well, the improvements in testing, etc., will mean a shorter time between having a potential issue and recognizing it as a real issue. That's really important, because with a lot of these things it's not like on CSI; you don't have half an hour and it all comes together. It is over days and sometimes weeks.

The point is that the shorter we can make that period...but at the same time, we don't always wait, and it's important to not just wait. So there is the regulatory process and the recall issues, etc., but there's also the public health process, so that if we have a suspicion, we actually speak to that and remind people of the importance of good food practice—because with many of these things, if you cook it properly, you've eliminated the problem.

[The Vice-Chair, Liberal, Joyce Murray]

Thank you.

Ms. Leslie.

[Megan Leslie, NDP, Halifax, NS]

Thank you, Madam Chair.

Mr. Farber, when you were telling me about the listeriosis policy, I'm not sure if I heard you talk about adding chemicals to food, or to the food production line. Is it specifically to food?

[Dr. Jeff Farber]

Yes, it's actually specifically to the food.

[Megan Leslie, NDP, Halifax, NS]

Okay.

Is there food that you can't add chemicals to? Obviously, prepared meats are....

[Dr. Jeff Farber]

There are foods you wouldn't necessarily want to add to. As Dr. Butler-Jones was mentioning about a risk-based system, you want to focus on those foods that have previously been involved in listeria outbreaks. For example, deli meats are obviously high-risk. You would want to add something like sodium diacetate to them to inhibit...but there are other foods that you cannot add to, because of their flavour characteristics. There are other foods, for example, that we know have never caused listeria outbreaks before.

[Megan Leslie, NDP, Halifax, NS]

Is there a correlation there? For example, the foods that you can add chemicals to tend to be the foods that have had the outbreaks and therefore are high-risk, versus foods you can't add chemicals to.

[Dr. Jeff Farber]

No, there is no correlation. The main thing with listeria, just so you understand, from all the risk assessments that have been done is that you really need to have fairly good growth of the organism to reach levels that actually cause disease. For example, let's say a listeria cell fell on a raspberry. Because the conditions within the raspberry are very acidic, you would not actually get any growth of the organism and you would probably get inactivation of the organism. It would be destroyed on that raspberry. So it really depends on the food and it's ability to support good growth.

So for the most part, we are talking about refrigerated foods, because listeria is an organism that we refer to as a psychrotrophic organism, meaning that it can actually grow at temperatures as low as four degrees Celsius in your fridge. Just to give you some context, if you take something like salmonella, which everyone knows about, it can't grow at four degrees Celsius. So the strategies you have to put in place are very different from one organism to another.

[Megan Leslie, NDP, Halifax, NS]

I'm clearly belying my ignorance about these issues.

So what do you do with food that can't be chemically treated and that is also high-risk?