खाद्य तथा दाना बस्तुहरुमा निर्धारित न्युनतम अनिवार्य गुणस्तर

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Bacillus cereus and food poisoning

Bacillus cereus and food poisoning

Excess iodine intake and its relation with thyroid dysfunction

 

For the control of Iodine Deficiency Disorder (IDD), Universal salt Iodization (USI) was implemented. As a result of it, Nepal is heading towards iodine sufficiency however the prevalence of clinical and sub-clinical hypothyroidism is still higher.The increased prevalence of thyroid disorders can be result of iodine deficiency or excess of iodine intake. The prevalence of excess iodine intake is hiking all over the world including Nepal. A study done in 1000 patients (with 270 clinical hypothyroidism patients) showed anti-TPO (Thyroid Peroxidase) antibody positive. The study also stated that the cause of hypothyroidism in present day Nepal was chronic autoimmune thyroiditis (Hashimoto's thyroiditis). As stated earlier, the status of iodine consumption in Nepal is moving from iodine deficiency to adequate or excess, there might be higher burden of thyroid disorders in Nepal due to the increased prevalence of autoimmune thyroiditis (Pokharel, S., 2019). 

A community based cross sectional study done in Udaypur (Nepal) in primary school aged children (6 years to 12 years) showed 10% (n=20) prevalence of thyroid dysfunction (sub-clinical hypothyroidism). Majority of the participants were reported to have excess urinary iodine concentration (UIC). The sensitive marker of recent dietary iodine intake is Urinary iodine rather than thyroid dysfunction. The analysis of thyroid hormones showed 1.6% of school age children had sub-clinical hyperthyroidism.

Although any apparent clinical consequences are not resulted by excess iodine exposure, thyroid dysfunction can occur in sensitive patients with specific risk factors, including those with pre-existing thyroid disease, the elderly, fetuses and neonates. The iodine-induced hypothyroidism or hyperthyroidism could be either sub-clinical or overt, hence excess iodine exposure should be suspected. The aeitology of thyroid dysfunction in not discernible.

Besides, Iodine Global Network (IGN) has highlighted several countries around the world to be categorized as having excess iodine status in population. As per study done in school age children in 6-9 years of age, IGN has listed Nepal in excessive iodine intake country. So, this could necessitate for the revisit of iodine standard in Nepal.

फलफुलको रसको प्रस्तावित गुणस्तर

WTO SPS नोटिफिकेसनको चरणमा रहेको "फलफुलको रसको प्रस्तावित गुणस्तर " देहाय बमोजिम रहेको देखिन्छ l  (श्रोत: एस पी एस इनक्वारी पोइन्टको वेब साइट ) l  तपाइको प्रतिकृया वा सुझाब तल दिनु होला l 

Opinion Poll on FDA

Is it time to revisit the standard of "Iodised salt"?

A paragraph from the recently published article: 

"WHO/UNICEF/IGN recommends that the iodine status of populations be based on the mUIC. It has been further designated that an optimal iodine intake is where a mUIC in school aged children (SAC) is in the range of 100–299 ug/L and excessive if the mUIC >300 ug/L (UNICEF, 2015). These levels are not as well defined for women of reproductive age, but for pregnant women, the optimal range is 150–249 ug/L, whereas the iodine intake is considered to be above requirements when the mUIC is between 250 and 499 ug/L and excessive >500 ug/L (WHO, 2013). With these criteria in mind, the 2016 survey shows that at the national level, SAC are currently classified in the “excessive” range, whereas pregnant women and women of child bearing age would be classified as “adequate” and “more than adequate,” respectively. Looking at the stratified results for several subgroups in the population, among the 34 strata listed, 19 (56%) were classified as excessive for SAC. Iodine intake was high in the central and western regions, in the Terai, and among a number of ethnic groups including the poorer Terai Janajati. For pregnant women, there were no strata with mUIC >500, but again, the sample size was small rendering these estimates imprecise. In addition, the assessment of iodine content of salt showed that mean iodine content for all salt samples was 44.1 ppm, and that 67.5% were >40 ppm—well above the expected level at the retail (30 ppm) and household (15 ppm) levels. The standards are based on an average per capita consumption of 10-g salt per day, so an iodine content this high will provide more than three times the daily requirement. These findings suggest that the current standard, combined with marked increase in use of a refined packaged product, may require an adjustment of the standard. "

WHO International Health Regulations Capacity Assessment

PDF Document "WHO BENCHMARKS for International Health Regulations (IHR) Capacities".

Please note that the chapter 5 of this document is specifically related to "Food Safety". Other chapters such as Antimicrobial resistance, Zoonotic disease, WASH, Public health etc are also directly or indirectly linked with food safety.  It shows the importance of food safety in the health sector. Food Safety is a shared responsibility. Government of Nepal and Ministry of Health and Population has got attention on the "National Food Control System" of Nepal. Let's hope that we can use this opportunity (or may be challenge?) for the betterment of all the Food Safety Professionals.

Does anybody have the evaluation report based on this benchmark? Where do we stand in this benchmark? It could be interesting to read and discuss further.

ISO/IEC 17025

Please find the document "ISO/IEC 17025: General requirements for the competence of testing and calibration laboratories" .

WHO SEARO Framework for action on Food Safety

The South-East Asia is home to one quarter of the world’s population. According to WHO statistics, “the burden of foodborne diseases in the region is the second highest among all WHO regions, accounting for 150 million illnesses, 175 000 deaths, and 12 million disability-adjusted life-years (DALYs) in 2010”. The comparison of global burden of foodborne disease by enteric hazards on different WHO regions is shown in figure.

 (WHO, 2015)

To fight with such challenges, WHO South-East Asia Regional Office has recently published a framework for action on food safety for this region. The framework has identified 7 important components of national food control system. The following strategic actions have been proposed under different components as described below:

"Component 1: Policy and legal framework

Strategic actions:
1. Develop, review and regularly update food safety policies, legislations and standards to include all requirements of a risk-based food control system, to address current emerging
issues, and to harmonize food legislations across various competent authorities in line with international requirements such as Codex Alimentarius Commission, the World Trade Organization the World Organisation for Animal Health (OIE), Sanitary and Phytosanitary (WTO SPS) agreement and Technical Barriers to Trade (TBT) measures, where applicable.
2. Disseminate food safety policies, regulations and standards through various means, including online tools such as official websites.

Component 2: Control management

Strategic actions:
Facilitate cross-sectoral coordination, integration of food control services and synergy in actions at the national and sub-national levels to achieve common food safety goals.

Component 3: Risk-based food inspection

Strategic actions:
1. Develop and implement risk-based inspection across the food chain.
2. Allocate adequate resources for inspection including appropriate inspection tools and sampling plans.
3. Establish a monitoring programme for specific contaminants and residues.
4. Develop guidance documents and tools for food business operators (FBOs) to develop food safety management systems such as good hygienic practices (GHP), good manufacturing practices (GMP), hazards analysis and critical control points (HACCP), traceability, recall, labelling, and food fraud vulnerability assessment and mitigation plan, and encourage them to conduct self-audit programmes.

Component 4: Data and information to support evidence-based control measures

Strategic actions:
1. Establish a national integrated data management system (data collection, central database, quality monitoring), conduct structured and timely data analysis for risk assessment, set standards, prioritize and participate in regional and international data sharing, e.g. Codex, global environment monitoring system (GEMS-food database).
2. Encourage utilization of information for evidence-based policy advocacy and decision making.
3. Collect and share data on FBD outbreaks through national disease surveillance systems (EBS and IBS).
4. Develop platforms for collaboration with academicians and researchers in conducting scientific studies to support risk assessment on food safety, conduct specific research to test hypotheses generated from FBD surveillance, and provide and sustain continued education for professional development of food safety officials.

Component 5: Data and information to support evidence-based control measures

Strategic actions:
1. Establish or have access to adequate laboratory services, including reference laboratories and satellite/mobile laboratory units equipped with reliable rapid test kits for on-thespot testing.
2. Develop and implement a laboratory network at the national and sub-national levels, collaborate with regional reference laboratories to improve efficiency and cost– effectiveness.
3. Develop and implement a sample management system.
4. Ensure that internal and external quality control/assurance systems (proficiency testing) for food testing are in place, including accreditation, where necessary.

Component 6: Preparedness and response to food safety emergencies

Strategic actions:
1. Develop, update and test cross-sectoral preparedness and response plans for food safety emergencies in line with the One Health approach and integrated with the NAPHS.
2. Use the INFOSAN community website/network to communicate on food safety incidents or emergencies and participate in identification/traceability/recall of implicated products.
3. Build or strengthen capacity to conduct investigation on FBD outbreaks and food safety events using the One Health approach.

Component 7: Food safety communications and education

Strategic actions:
1. Develop education and capacity-building programmes on food safety for professionals through various means, including online training.
2. Establish guidance documents for FBOs to manage food safety risks in line with national requirements.
3. Identify training needs and provide assistance/encouragement to FBOs to deliver continuous education and communication on food safety for all personnel involved in the food chain.
4. Provide food safety awareness and training for food handlers/street food vendors/ small-medium enterprises (SMEs) to improve hygiene and food safety practices.
5. Develop and implement consumer awareness programmes promoting food hygiene practices, food labelling, healthy diets, food allergy prevention, including the “Five keys for safer food” through various means such as online communication channels
(e.g. official websites and social media) as per country context and needs of the target population.
6. Review and update available food safety information regularly.
7. Design and provide tailored and specific food safety information targeting vulnerable populations (infants, pregnant and lactating mothers, the elderly and immunocompromised).
8. Develop appropriate mechanisms to monitor public concerns and social media information on food safety and response.
9. Develop media and FBO sensitization programmes on food safety.
10. Encourage incorporation of food safety-related lessons and activities in school. "

The strategic actions proposed by WHO could be a good reference for upgrading the food control system of Nepal. Moreover, government of Nepal has recently approved “national food safety policy 2076”. However, the level of advocacy of the document is almost absent. I had difficulty finding the correct document last week. It was very strange but a bitter truth. We were confused even in the name of the document. It shows the level of importance that we have given to it. It was difficult finding the document even in the website of DFTQC. Thankfully, it was available in the website of SPS enquiry point. It shows the level of importance we have given to the national food safety policy. Does it mean that the document was prepared only as a showpiece and not for implementation? If it was not necessary, why did we use so much resources and effort to formulate it?

There was a time when we used to blame “lack of food safety policy” for all our weakness and incapability. We don’t have that excuse anymore. This document now exists, but probably sleeping inside our showcase or drawer. I would like to request all the food safety professionals to read it once, because it is our bible/geeta (whatever you like to say). We should wake this document up and implement it, if we really want to upgrade the food control system of Nepal.

Hope, our seniors have something to say about it. Waiting for your feedback.

Click here to read National food safety policy 2076.

References:

Framework for Action on Food Safety in the WHO South-East Asia Region. New Delhi: World Health Organization, Regional Office for South-East Asia; 2020. Licence: CC BY-NC-SA 3.0 IGO.

WHO estimates of the global burden of foodborne diseases: foodborne disease burden epidemiology reference group 2007-2015