Food Protection Trends - August 2010 - 489

enteritis” was the specified cause in 25% of the reports for the year, and cholera was specified in 18%. Reports documenting chemical contamination occurred more frequently in this region than in the other regions studied, being identified in 24% of the reports in the first quarter and 29% of those in the fourth quarter (Table 1). Food recalls and warnings were issued in 36% of the outbreaks, which is slightly more frequently than in any other region included in this study. Interestingly, given the lack of seasonal variability in the reports from this region, warnings declined in the final quarter, from 39% in the first quarter, 38% in the second, and 39% in the third to 28% in the fourth quarter (Fig. 3). Outbreaks in this region most commonly affected 11–100 persons, which was similar to data from the European region. However, both smaller and larger outbreaks were commonly reported. Very small (0 to 1 case) and large (101 to 1,000 cases) outbreaks each contributed 20% of the reports. Outbreaks affecting 11 to 100 persons were reported in one-third of the reports (Fig. 4). Deaths were reported in 21% of the reports in the first quarter. Afterwards, mortality rates decreased to 11% and 10% of the reports in the second and third quarter, respectively, but increased to 18% in the fourth quarter. The mortality rate was lower than in Africa, as only a few reports mentioned deaths in the 11–100 range, and there were no reports of outbreaks with mortality of over 101 persons (Fig. 5). Note: Outbreak reports collected from the Western Pacific region in the first quarter of 2009 (January to March) were analyzed in English and in Mandarin. The researchers found many additional outbreaks reported in Mandarin that were not covered in the English media. Between January and March 2009, 16 reports were carried in Mandarin exclusively and therefore were not accessed by our regular methods of information gathering.

DISCUSSION
The researchers tracked the reporting of foodborne and waterborne disease outbreaks through reports that were publicly available in the media and that were from international and non-governmental organizations. Such informal

reporting systems are available in every region. This research provided preliminary evidence that informal reporting systems can provide valuable information that can be used to compare the burden of foodborne and waterborne diseases in different regions. The researchers analyzed public reports of foodborne and waterborne outbreaks in three regions: one with highly developed surveillance systems (Europe), one with less developed surveillance systems (Africa), and one with intermediate systems (the Western Pacific region). Surveillance systems vary greatly from region to region. Several countries have sophisticated surveillance systems that can support formal estimates of the burden of foodborne disease, while many others have rudimentary or developing systems. For further research, it would be valuable to compare informal reporting results with the formal estimates available in some countries. Seasonality was more evident in both Europe and Africa than in the Western Pacific region. In Africa, the pattern of cholera outbreaks seemed to correlate strongly with the rainy season in the end of the fourth quarter and the beginning of the first. In Europe, the surveillance system provided more specific identification of pathogens causing the outbreaks, allowing observation of seasonality, such as the increase in Norovirus reports in the winter and fall months of the fourth quarter. In the Western Pacific region, seasonal trends were difficult to observe and identification of pathogens was relatively unspecific, necessitating the use of more general categories such as “contamination” and “gastroenteritis.” With respect to vehicle attribution, it was observed that the outbreaks linked to food were more common in Europe and the Western Pacific region than in Africa, which reported more waterborne outbreaks than the other two regions. Outbreaks with an unspecified vehicle were reported in every region, although the proportion varied greatly by season in each region. The pathogens identified varied widely between regions. Despite having the highest number of outbreak reports, Africa had the least diversity among the pathogens reported, as 82% of the reports identified the cause as “cholera” (Vibrio cholerae). The consistency of this narrow finding led the researchers to postulate that use of the term “cholera” may

not be the result of a laboratory finding, but rather may indicate a non-specific category of diarrheal diseases. Europe identified Salmonella, E. coli and Norovirus most frequently and overall identified a much greater variety of pathogens in its reports. The Western Pacific region had no specific pathogen that dominated the reports, and its reports used nonspecific terms, e.g., “contamination.” Also, that region reported more chemical contamination problems than either of the other two regions. Food recalls and warnings were issued by governments in a minority of the outbreaks reported. The region with the greatest number of such consumer alerts (recalls and warnings) was the Western Pacific region, where recalls or warnings were reported in approximately 36% of the outbreaks. Europe issued alerts in approximately 34% of the outbreaks, and alerts were least frequent (20%) in the outbreaks reported from the African region. The most frequently reported range of illnesses was 11–100 persons for each region during most of the seasons. Africa was an exception for the first two quarters, when the most frequent range was 101–1000 persons. This may indicate that surveillance was more efficient in Europe and Western Pacific than in Africa, because these regions were better able to issue recalls and warnings and publicize outbreaks before more than 100 persons became ill. The rates of mortality showed the greatest differences between the regions. In Africa, mortality was reported in 70% of the outbreak reports, and the proportion of outbreaks with mortality of over 100 persons was very high, especially in the fourth quarter (42%). The European region had lower mortality rates, perhaps as a consequence of less potent pathogens circulating in the region or better outbreak surveillance systems that ensured more rapid control of outbreaks.

CONCLUSION
At the level of international governance, there is increasing focus on infectious diseases, especially those at the interface of humans, animals and the ecosystem, under the One World, One Health Strategic Framework. This framework was developed by the Food and Agriculture Organization (FAO) of

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Food Protection Trends - August 2010

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