LISTERIOSIS OUTBREAK TRANSBOUNDARY MULTIDISCIPLINARY APPROACH Presented by Paulina
LISTERIOSIS OUTBREAK – TRANSBOUNDARY MULTIDISCIPLINARY APPROACH Presented by: Paulina Radebe
Presentation Layout • Press release on literiosis • What is listeriosis • Role of MHS on disease outbreak • Introduction to MHS (Legislative Framework) related to food control
Presentation Layout • First action by FDDM in responding to the National call on the listeriosis outbreak • Stakeholders involvement • Transboundary and multidisciplinary approach • Activities that took place during the outbreak
Press release on Lsteriosis • On 5 December 2017 the South African Minister of Health announced that South Africa was hit by the outbreak of listeriosis. • A joint Public Health Emergency Co-ordinating Committee was established which included NDo. H, DAFF, DTi, NCC, NRCS, DEA, SALGA and DMs to co-ordinate investigations and response.
Press release on Literiosis • On the 3 rd March 2018, the National Institute for Communicable Disease (NICD), working together with partners present here today, confirmed that source of the Listeria outbreak strain (Lm ST-6) was a ready-to-eat (RTE) processed meat plant owned by Tiger Brands (the Enterprise Foods® Polokwane production facilityand also identified Listeria at a RCLowned facility (Rainbow Foods®) situated in Sasolburg, Free State Province.
Literiosis? • Serious but preventable disease cause by the bacterium, listeria monocytogen • Lives in the soil and food. • Incubation period is between 3 to 10 days and averages 21 days
Where to find Literiosis? • contaminated food products including unpasteurised milk , soft cheeses, vegetables, processed foods, ready-to-eat meats • It can survive in (4°C) refrigeration temperatures
Who is at risk - Literiosis? • Pregnant women and the new-borns • Adults 65 years + • Children ˂ 12 years • Immuno-compromised individuals
Role of MHS on the Listeriosis Outbreak: Legislative Framework • The Municipal Structures Act (No. 117 of 1998) section 84 (1) (i) stipulates that district and Metropolitan municipalities in South Africa have the power and responsibility to render municipal health services in their areas of jurisdiction. • Section 32 (1) - National Health Act (No. 61 of 2003) : metropolitan and district municipalities must ensure that municipal health services are effectively and equitably provided in their respective areas
Role of MHS on the Listeriosis Outbreak: Legislative Framework Cont… • This same 2003 Act goes further to define the term “municipal health services” as including: 1. Water quality monitoring; 2. Food control; 3. Waste management; 4. Health Surveillance of premises;
Role of MHS on the Listeriosis Outbreak: Legislative Framework Cont… 5. Surveillance and prevention of communicable diseases, excluding immunizations; 6. Vector control; 7. Environmental pollution control; 8. Disposal of the dead; and 9. Chemical safety,
Role of MHS on the Listeriosis Outbreak: Legislative Framework Cont… • These exclude malaria control and control of hazardous substance, which is a competency of provincial health
Role of MHS on the Listeriosis Outbreak: Legislative Framework Cont… • These exclude malaria control and control of hazardous substance, which is a competency of provincial health
Role of MHS on the Listeriosis Outbreak: Legislative Framework Cont… • The Constitution of the Republic of South Africa, (108 of 1996) allocates MHS as Local Government function under Part B of Schedule 4, section 156(l)(a) • The functions of an EHP is further legislated in the Scope of Practice for Environmental Health Practitioners (Regulation 698 of 2009) under Health Professions Act (No. 56 of 1974) • The above Act (No. 56 of 1974) prohibits any other individual to practice as an EHP than a qualified, registered, paid up health practitioner with HPCSA
RCL premises: Location • Sasolburg • Mafube Local Municipality • Fezile Dabi District Municipality
Orientation on FDDM locality
Ratio EHPs per population vs WHO requirement Extent of Municipalit y (km²) Population Current EHP status + EM support WHO requirement Metsimahol o 1717 149108 +3 15 Moqhaka LM 7925 160532 1 16 Ngwathe LM 7055 120520 2 12 Mafube LM 3971 57876 2 6 MHS EHP Managers 3 Com. Serv. EHPs 1 TOTAL 20668 488036 5+3 49
THE ROLE OF MHS AS PER SCOPE OF PRACTICE Cont… Food control • Evaluate food premises, food transportation inspections and issuing of certificate of acceptability for complying premises • Conduct EH risk assessment of premises (food risks, water, sanitation, waste management, hygiene practices, pest control, complaints from public)
THE ROLE OF MHS AS PER SCOPE OF PRACTICE Cont… Food control cont. . . • Compliance monitoring in terms of legislative requirements and instituting remedial and preventative measures • Sampling and analysis of foodstuff as well as examination of food labels • Workshops and education on food safety to formal and informal premises
Action by MHS • 14 February 2018 – FDDM in the presence of NICD and Provincial Do. H took samples at RCL • 02 March 2018 – Results from the lab confirming positive Listeria Monocytogenes in some areas within the facility. This included the high risk area. • 05 March 2018 – FDDM issued a compliance notice/ Order of instruction (with recommendations) for closure to
Action by MHS • On 4 March 2018, the Minister instructed that all ready-to-eat processed meat products produced at these facilities be recalled immediately. • RCL had already been pro-active with the recall and had taken all possible avenue to ensure the success of the recall process. They provided proof to this effect.
Action by MHS • 10 March 2018 – MHS inspections – establish if RCL has ceased with their operations and to determine their plan going forward. – Water samples – one sample was confirmed positive Listeria Monocytogenes. Results were communicated to them and recommendations given for rectifications.
Action by MHS • 14 March 2018 - RCL sent the Draft Action Plan to stakeholders through Provincial Do. H for consideration and inputs. • 19 March 2018 – Draft Action Plan was discussed with stakeholders for further inputs (NRCS, Provincial Do. H and MHS)
Action by MHS • 23 March 2018 – FDDM MHS sent consolidated inputs to RCL for endorsement, amendment and incorporation into RCL draft action plan. • Between 05 March and 9 April 2018 – RCL revamped their place and put new measures in place, deep cleansing the area, etc. . . then requested MHS to sample their facility
Action by MHS • 10 April 2018 – 494 samples (environmental swabs) were taken. 197 were taken by FDDM MHS as well 100 duplicates while 197 set of duplicate was taken by RCL. 197 samples taken by FDDM were taken to Microchem and 100 to NHLS for analyses, while 197 taken by RCL was taken to Swift.
Action by MHS • 11 April 2018 – Meeting with National and Provincial Do. H, RCL and FDDM MHS to determine the implementation of revised action plan by RCL and wayforward. • 17 April – Results from the two Swift and Micro. Chem were received (394 collectively). All samples except for one showed negative of listeria Monocytogen. Results from NHL are still pending.
Action by MHS • Between 18 – 24 April 2018 – FDDM MHS consulted and engaged Provincial and National Do. H for advice and support on the FDDM Granting temporary lifting of the suspension notice of RCL. After all factors were taken into consideration, Do. H gave their support to FDDM request.
Action by MHS • 26 April 2018 – (Temporary) Lifting Notice served to RCL to enable the facility to be operational. • MHS walk through for assessment
Action by MHS – NB: Temporary upliftment (in this case) means: commission to be embarked on. Environmental swabs will be taken by MHS epecially in high risk area, products samples (three consecutive product samples. All the samples are expected to be negative (products and high risk area) then a temporary will fall off, thus a full upliftment notice will be issued.
Action by MHS • If samples fail, closure will be enforced until such conditions are addressed and compliance is attained (at high risk area and or products). • 03 May 2018 – Stakeholders visit to RCL for inspection • MHS continued to monitor the facility as per scope of practice and in line with the Norms and Standards for EHPs
Action by MHS • April and May MHS personnel attended Listeria Outbreak workshops • As part of risk profiling for meat processing premises - On 16, 25 and 28 May 2018 MHS did a thorough inspection at the facility (using an National Do. H Inspection Check list), then sent an inspection report with recommendation for implementation.
Action by MHS • In August 2018 RCL notified MHS that they had taken the samples in their premises and sent the results thereof to MHS. • MHS took the “verification” samples (environmental swabs and polony) on 11 September 2018 and send then to NICD for analyses.
Action by MHS
Activities • On 4 March 2018, Minister of Health issued an instruction that all ready-to-eat processed meat products produced at the affected facilities be recalled immediately.
Involvement of stakeholders • Worked closely with Incident Management Team comprising of officials from NDo. H, NICD, NHLS, Department of Trade Industry, National Consumer Council, National Regulator for Compulsory Specifications
Involvement of stakeholders • Department Agriculture, Forestry and Fisheries, Environmental Affairs, South African Military Health Services, SALGA and District Municipalities (Tshwane, City of Johannesburg and Ekurhuleni)
Involvement of stakeholders • A joint Public health emergency Coordinating committee including NDo. H, DAFF, DTi, NCC, NRCS, DEA, SALGA and DMs to coordinate investigations and response
Involvement of stakeholders inspections and advice
Involvement of stakeholders Sampling
Involvement of stakeholders Meetings & continuous engagement
Benefits • Co-operation and improved communication in all levels. • Mutual trust and respect between government and private sector and amongst government sectors. • Improved working relations and approach.
Benefits • Transboundary and multidisciplinary approach and engagements • Team work internal and external • Enhanced good relationship between various sectors of government and private sectors • Improved relationship and support in government by government
Thank You
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