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Introduction
Following
the recent earthquake and associated tsunami in South
East Asia, food in the affected areas may become
contaminated and may contribute to outbreaks of diarrhoea and dysentery
including cholera, hepatitis and typhoid. Conditions of poor sanitation as
well as inadequate areas for food preparation can cause massive outbreaks of
foodborne disease or high numbers of isolated single cases potentially later
leading to larger, recognized outbreaks. As persons suffering at the hands of
the disaster may already be immuno-compromised
through malnutrition, exposure, shock and other traumas associated with such
disasters, it becomes even more important to protect the food reaching them.
This guide is intended to:
1. provide
health and emergency preparedness authorities guidance on key food safety
issues to be considered in such a disaster situation;
2. remind
authorities of the need to maintain existing support for food safety;
3. reinforce
the need to be especially vigilant against the possible introduction of new
health risks at this time;
4. serve as a guidance for crash training of those
involved in emergency food aid, such as refugee camp managers and NGO’s.
The guidance is modelled after the standard “WHO
Five Keys to Safer Food” and recognizes the importance of addressing the
safety of food along the length of the food chain.
While contamination can
always occur at all points of the food chain, inadequate washing, handling
and cooking of food just before consumption is still a prime cause of
foodborne disease. Many disease cases
are preventable by observing simple hygienic rules during food preparation,
be that in small family setting or in larger food preparation units.
Therefore in an Annex to
this guide specific guidance to anyone involved in food preparation is
given. This guidance can be useful for the ordinary population or for people
involved in any level of mass catering. The guidance is modelled
after the standard WHO Five Keys to safer food.
More information is available in the WHO publication ”Environmental Health in Disasters and Emergencies”, 2004, Chapter 9 , at http://www.who.int/water_sanitation_health/hygiene/emergencies/emergencies2002/en/
1.
Preventive food safety measures after a tsunami
Following the recent tsunami,
food may become contaminated by surface water that has
itself been contaminated by sewage and wastewaters carrying pathogenic
bacteria from sewer systems, septic tanks, latrines and probably animal
farms. The following issues should be investigated:
 If crop fields have been contaminated by human
excreta, following floods or damage to sewerage systems, an assessment should
be carried out rapidly to assess the contamination of crops and to establish
measures, such as delayed harvesting and thorough cooking, to reduce the risk
of transmitting faecal pathogens.
Food industries, slaughterhouses, markets and
catering establishments should be inspected and steps taken to ensure their
safe operation and that foods that have been
adversely affected are not marketed.
Foods that have not been affected should be
protected against exposure to other sources of contamination and not kept
under conditions in which bacterial growth may occur. In warehouses that have
been flooded, whatever intact foods remain should be moved to a dry place,
preferably away from the walls and off the floor.
Any food stocks found to be unfit for human
consumption must be disposed of -- used for animal feed, industrial purposes
or destroyed -- under the supervision of the public health authorities in a
manner that ensures that the items will not be used for human consumption;
the disposal should be documented.
When salvaged foods are fit for consumption
and sold, they should be labelled accordingly. If necessary, consumers should be clearly
informed of measures they need to take to render them safe.
Safe and hygienic warehouse
management must be assured:
Storage structures should have good roofs and
ventilation. Products should be kept at least 40 cm from walls and 10cm from
the floor. Bags must not lie directly
on the floor – pallets, boards, heavy branches, bricks, or clean, dry plastic
bags or sheets should be placed underneath them. Bags should be piled
two-by-two cross-wise to permit ventilation.
Wet bags should be allowed to dry in the sun before storing them.
Damaged bags should be rebagged and stored apart
from undamaged ones. A reserve of good-quality empty bags should be kept for
this purpose.
Spilled food should be swept up and disposed
of promptly to discourage rats. Spills
of cooking oil in the warehouse should be immediately cleaned up to prevent workers
slipping and injuring themselves.
Similarly, containers should not be piled too high and piles should be
stable so that workers are not injured by falling items.
Fuel, pesticides, chlorine and other chemical
stocks should never be stored in the same place as food.
If spray operations for pest control are
needed, they should exclusively be carried out by official technical staff,
under the close supervision of the national authority (Health Ministry /
Ministry of Agriculture). Wearing of protective gear for head, mouth, hands
and body are a must to reduce exposure of the operators to toxic chemicals.
During the emergency response
operations, there may also be improvised, large-scale preparation of cooked
food and/or the distribution of imported or locally-purchased food items. In
this context special attention must be brought to the fact that:
Some food commodities distributed may not be
fit for human consumption, and that
Food contamination can occur during 'mass
feeding' operations.
Thus:
All foods used in mass feeding or food
distribution programmes must be fit for human consumption (as well as being
nutritionally and culturally appropriate), for this:
 The quality and safety of all items should be
controlled before importation or local purchase and any unfit items be rejected.
Stocks should be regularly inspected and any
suspect stocks should be separated from other stocks and samples be sent to a
public health laboratory for analysis; in the meantime they should not be
used.
In feeding centres/
refugee camps, food hygiene must be assured:
Kitchen supervisors, cooks and ancillary
personnel should be trained in personal hygiene and the principles of safe
food preparation (See Annex).
Centre / camp supervisors should be trained to
be able to recognize potential hazards and emphasize appropriate food safety
measures; the personal hygiene of personnel involved in food preparation
should be monitored.
Employees and volunteers preparing food should
not be suffering from an illness with any of the following symptoms:
jaundice, diarrhoea, vomiting, fever, sore throat (with fever), visibly
infected skin lesions (boils, cuts, etc.), or discharge from the ears, eyes
or nose.
Cleaners should be employed to keep the
kitchen and surrounding areas clean; they should be properly trained and
their work supervised and there must be adequate facilities for waste
disposal.
Water and soap must be provided for personal
cleanliness, and detergent for cleaning utensils and surfaces which should
also be sanitized with boiling water or a sanitizing agent, e.g. bleach
solution.
Foods should be stored in containers that will
prevent contamination by rodents, insects; or other animals,
refrigeration may have to be improvised. The five keys to
safer food should be followed meticulously.
2.
Food safety requirements in mass feeding centres
All
foods used in mass feeding or food distribution programmes must be fit for
human consumption.
Stocks
should be regularly inspected and any suspect stock should be separated from
other stock and samples be sent to a public health laboratory for
analysis. In the meantime the suspect
food should not be used.
All
kitchen supervisors, cooks and ancillary personnel should be trained in
personal hygiene and the principles of safe food preparation.
The
personal hygiene of personnel involved in food preparation should be
monitored.
Supervisors
should be able to analyse potential hazards and
emphasize appropriate food safety measures.
Employees
and volunteers preparing food should not be suffering from an illness with
any of the following symptoms: jaundice, diarrhea, vomiting, fever, sore
throat (with fever), visibly infected skin lesions (boils, cuts, etc.), or
discharge from the ears, eyes or nose.
Cleaners
should be employed to keep the kitchen and surrounding areas clean; they
should be properly trained and their work supervised and there must be
adequate facilities for waste disposal
Water
and soap must be provided for personal cleanliness,
Utensils
that should be washed in boiled or treated water.
Foods
should be stored in containers that will prevent contamination by pests and
stray animals.
Raw
meats, fish and poultry should be separated from ready-to-eat and cooked
food.
Consumer
education and information
Information and advice must be provided
to the population, especially important is to:
remind the population that dangerous
communicable disease outbreaks in disaster regions has the potential to claim
as many lives as the disaster itself, and that safe water and safely prepared
food are the two main factors to prevent such outbreaks.
remind people of the key behaviours of safe
food handling and preparation
when food is likely to be contaminated by
chemicals from warehouses, chemical plants, and other sources, advise people
to avoid those types of food
In many cases, consumers will be
preparing food under conditions that are more primitive than normal, due to
lack of water supply and electricity, especially for the case of the homeless
people. In any event, consumers should be encouraged to take special care
regarding food safety from the procurement of raw materials and water,
through handling and preparation to final consumption. In this regard, WHO's Five Keys to Safer
Food have been modified to the current tsunami
disaster sonditions. This version is presented in
the Annex and may be further adapted to the local situations.
3. Inspecting and salvaging food
Where food businesses, retailers,
marketplaces, restaurants, bakeries and other sources of food remain
operational in the affected area, inspectors should inspect the premises and
take all steps necessary to ensure that foods that have been adversely
affected are not marketed.
When salvaged foods are fit for consumption
and sold, they should be labelled accordingly and
consumers should be clearly informed
of measures they need to take to render them safe.
Assessing and using salvaged pre-packaged food
Discard canned foods
with broken seams, dents, or leaks; and jars with cracks.
Undamaged canned goods and commercial glass
jars of food are likely to be safe.
However, if possible you should sanitize the containers before opening
them for use. To do this, wash the jars and cans thoroughly. This may result in loss of labels so mark
contents on can or jar lid with indelible ink before washing. Finally, immerse containers for 15 minutes
in a solution of 2 teaspoons of chlorine bleach per quart of room temperature
water. Air dry before opening.
Foods that are exposed to chemicals should be
thrown away. The chemicals cannot be washed off the food. This includes foods
stored at room temperature, like fruits and vegetables, as well as foods
stored in permeable containers like cardboard and screw-top jars and bottles.
Assessing and using salvaged refrigerated food
Inspect refrigerators to determine if they
have been affected by flood waters.
Where refrigerators and cold food have not been directly affected by
flood waters they may be a suitable source of safe food.
Where power is not available, try to use
refrigerated food before it is held in the danger zone (5-60oC) for more than
two hours, especially meat, fish, poultry and milk.
To avoid disposing of meat fish, poultry and
milk and wasting what might be valuable nutrients it could be placed in a
freezer immediately if it hasn’t reached the danger zone or cooked and frozen
if it is to be kept longer.
Some foods normally stored in the refrigerator
can be kept in the danger zone for longer than others. Under such emergency conditions it is
likely that foods such as butter, margarine, fresh fruits and vegetables;
open jars of concentrates and sauces; hard and processed cheeses; and fruit
juices can be kept and used for a period but they should definitely be
discarded if they show signs of spoilage (odour,
texture, gassiness, mouldiness).
To prevent warm air from entering the
refrigerator, open it only when necessary.
1. Assessing and using
salvaged dry stores of food
Check all food for physical hazards (such as
glass) that may have been introduced during the earthquake.
The likelihood of mould growth on stored
vegetables, fruits and cereals is greater in a humid environment and where
food has become wet. Mould growth can
be associated with chemical toxins.
Intact food should be moved to a dry place,
away from the walls and off the floor! Bags must not lie directly on the
floor – pallets, boards, heavy branches, bricks, or clean, dry plastic bags
or sheets should be placed underneath them. Bags should be piled two-by-two
cross-wise to permit ventilation.
Wet bags should be allowed to dry in the sun
before storing them.
Damaged bags should be rebagged
and stored apart from undamaged ones. A reserve of good-quality empty bags
should be kept for this purpose.
Spilled food should be swept up and disposed of promptly to discourage rats.
4.
Food Provision after the Earthquake and Tsunami caused conditions
Agricultural produce harvested from or
stored in affected areas
The
protection of food requires attention along the food chain.
While
much of the normal agricultural production may be adversely affected by
flooding associated with a tsunami, there may be areas where food can still
be harvested or where food has been stored safely post harvesting.
If
agricultural produce is harvested from an area affected with flooding it may
be contaminated with microorganisms (from raw sewage or decaying organisms) and
chemicals in the flood waters. While it is possible to reduce the potential hazard
associated microorganisms by thoroughly cooking the produce, such actions may
not remove chemical hazards. Therefore
only harvest food from affected areas where it is necessary and where you can
be confident that chemical contamination has not occurred. Also ensure the product is properly identified
as being harvested from an affected area.
Similarly
agricultural produce that was stored in the affected areas at the time of the
disaster may also be affected by the flood waters. Such food should be treated as with food
harvested from affected areas.
Providing dry rations for
household cooking
After
a disaster, as soon as families have reestablished their capacity to cook,
any food they may be given is usually distributed in dry form to prepare and
consume in their homes or temporary shelters. In addition to safe water for
food preparation, a means of washing hands and utensils will be needed.
People may not always be familiar with all kinds of dry foods. When given,
they should be shown how to prepare dry foods.
A
shortage of fuel for cooking may also be a major constraint, and this may
need to be supplied to ensure adequate cooking and reheating of cooked food.
In
some cases, as an alternative to mass feeding, it may be possible to help
households by providing dry rations that do not need cooking or by setting up
temporary shared neighbourhood kitchens where
people can prepare food for their own families or in groups.
5. Response to
an outbreak of foodborne disease
It is vital to detect food borne
diseases as early as possible. Indications of a foodborne disease outbreak
that should trigger an investigation include:
reports
from health workers,
reports
from pharmacists of an unusual demand for anti-diarrhoeal agents,
anti-emetics or other medication for gastrointestinal problems, e.g.
antibiotics
an
upsurge in inexplicable customers’ complaints to a food supplier, food
industry
coroner’s
report of unusual death
unusual
absenteeism from schools and the workplace, especially in large
industries
Detection may also be through an existing communicable disease surveillance systems if
the cluster is large enough (and there is no separate food-borne disease
surveillance system).
Investigation of and response to a suspected food safety emergency involves:
rapid
identification of the causative agent and the suspected foods by patients
interviews and by appropriate diagnostic laboratory testing
epidemiological
investigation to identify the causative agent, the responsible food and the
manner of contamination including: collection, transport and processing of
samples; collation of information about sources of contamination and
coordination with law enforcement, food safety regulatory authorities,
industry, emergency medical response agencies, and (when imported food may be
involved) quarantine and customs agencies (swift communication among all
these entities is essential)
timely
treatment of exposed people
removal
(recall) of the contaminated food from circulation (This should be
coordinated by the national food safety agency in collaboration with the food
industry and other food providers)
timely
provision of information to the public
on food-related risks and the actions they should take to minimize those
risks; the information must be conveyed in a manner that is culturally
appropriate and does not cause unnecessary anxiety
The effectiveness of response
depends to a great extent on preparedness including
a) the capacities for
investigation and verification, and
b) coordination
between relevant government and other agencies that contribute to managing
the public health consequences.
Annex:
5 Keys for Safer Food - in regions hit by disasters
The information provided is intended to present
the five core food safety messages as they could be presented to people
involved in food preparation in areas affected by the Tsunami disaster
26.12.04. While it should be realized that some of the instructions mentioned
here will not be practicable in all situations, attempts to adhere as best
possible to the general keys will contribute to disease prevention. The general 5 keys, including translation into local languages can be found at www.who.int/foodsafety
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