食品安全1

Foodsafety,HazardAnalysisandCriticalControlPointandtheincreaseinfoodbornediseases:aparadox?

YasmineMotarjemi*,FritzK󰁿afersteinWorldHealthOrganisation,FoodSafetyUnit,DivisionofFoodandNutrition,20AvenueAppia,CH-1211Geneva27,SwitzerlandReceived17October1998;receivedinrevisedformandaccepted14December1998

AbstractTheapplicationoftheHazardAnalysisandCriticalControlPoint(HACCP)systemisrapidlyprogressing,inparticularinlargeandmediumscalefoodindustries.Thetermisbecomingwellknowninfoodcontrolandpublichealthcirclesandisonewhichevokesfoodsafety.However,concomitantwiththeheadwayoftheHACCPsysteminfoodsafetymanagement,theincidenceoffoodbornediseasesisincreasingworldwide.DoestheincreaseinfoodbornediseasesrepresentaparadoxorfailureoftheHACCPsystem?TheHACCPsystemisnotapanaceaforallfoodsafetyproblems.Itisatoolthatguidesfoodsafetyassurancepersonnelintheidenti®cationofpertinenthazardsandcontrolmeasures,ensuringthatthosewhicharecriticalforfoodsafetyareappliedcorrectly.Inthisway,itenhancesthesafetyofthefoodsupply.WhiletheapplicationoftheHACCPsystemcanimprovefoodsafetyinallsituations,itsstrengthandsuccessinpreventingfoodborneillnessesdependonitbeingappliedcorrectlyandincombinationwithotherfoodsafetymanagementsystems,includingtheprovisionofasanitaryinfrastructureandtheapplicationofprinciplesofgoodhygienicpractice.Thepaperpresentsthereasonsfortheincreaseinfoodbornediseases,therolethattheHACCPsystemplaysinpreventingfoodbornediseases,thedeterminantsofitssuccessandfailure,andthecontributionwhichcanreasonablybeexpectedfromtheimplementationoftheHACCPsystemtopublichealth.Ó1999ElsevierScienceLtd.Allrightsreserved.Keywords:HACCP;Foodsafety;Foodbornedisease;Goodhygienicpractice;Foodcontrol

1.Introduction

In1991,acholeraepidemicsweptovertheLatinAmericancontinent,resultinginover250000casesofcholeraandabout2700deathswithinoneyear.Afewyearslater,anewlyrecognizedtypeofdisease,theEHECinfection,seizedJapanbysurpriseandinonesingleoutbreaka󰂀ectedmorethan9500people,mainlyschoolchildren.11peopledied.Thesetwomajorepidemics/outbreaksoffoodbornediseases,includingmanyothers,largeandsmall,whichhaveoccurredinrecentyearsaroundtheworld,havealertedpublichealthauthoritiestotheloomingproblemoffoodbornediseases.Theyareawarningthatanycountry,regardlessofitsstageofdevelopment,canbea󰂀ectedbyfoodbornediseasesandthatthesecanbeverydeadly,inparticularforvulnerablegroupssuchasinfantsandchildren,theelderly,pregnantwomenandimmunocompromisedpersons.Theyalsoremindthepublichealthauthoritiesthatwiththeindustrializationandglobalizationofthefoodsupplyandwiththemodernlifestyle,foodbornediseasescanstrikeapopu-lationinmassesanddisruptthehealthsystemofun-preparedcountries.Throughpopulationandotherepidemiologicalsur-veys,thepublichealthauthoritiesinanumberofcountrieshavefurthermorecometorealizethatthecasesoffoodbornediseasesreportedtotheauthoritiesconstitutethetipoftheicebergonlyandthatanevengreaternumberofvictimssu󰂀erinsilencewithoutthesecaseseverbeingreported.Intheindustrializedcoun-tries,theincidenceoffoodbornediseasesisestimatedtobeunder-reportedbyafactorof100±350,dependingonthenatureofthedisease,perceptionoftheriskofthediseaseandthehealthsystem.Today,itisestimatedthatthereareapproximately4000millioncasesofdiarrhoealdiseaseannuallyintheworld,mainly±butnotexclusively±inthedevelopingcountries.Some1500millionepisodesofdiarrhoeawww.elsevier.com/locate/foodcontFoodControl10(1999)325±333

*Correspondingauthor.Tel.:+41-22-791-21-11;fax:+41-22-791-07-46.E-mailaddress:motarjemiy@who.ch

0956-7135/99/$-seefrontmatterÓ1999ElsevierScienceLtd.Allrightsreserved.PII:S0956-7135(99)00008-0occurinchildrenundertheageof®ve.Inthedevelopingcountries,somechildrenarea󰂀ectedbyupto10±12episodesperyear.Over3millionchildrensuccumbasaresult.Theassociationofdiarrhoealdiseasesandmalnutritioncausesanevengreaternumberofdeaths.Food(includingdrinkingwater)isthemajorvehicleforthesediseasesandisthecauseofupto70%ofthecases.Inindustrializedcountries,upto10%ofthepopulationareestimatedtosu󰂀erannuallyfromafoodbornedisease.Theproblemoffoodbornediseasesisbeyondimagi-nation.Thecruelfactisthatinsomepartsoftheworldtheiroccurrenceissofrequentthattheyhavebecomeafactofeverydaylife.Inagreatnumberofcountries,eitherduetolackofresourcesorawareness,thepublichealthauthoritiesundertakeveryfewmeasurestoin-vestigateorpreventfoodbornediseaseslesttheybecomeanobstacletofoodexportortourism.Althoughtheproblemoffoodbornediseasesisnotanewpublichealthproblem,theproblemhastakenanewdimensionattheendofthe20thcentury,bothintermsofmagnitudeandintermsofhealthconsequence.Aswillbediscussedlater,manyfactorsrelatedtothefoodsupplysystem,healthanddemographicsituation,life-style,thehealthsystemandinfrastructure,andtheen-vironmentalconditionsofthecountryin¯uencetheirprevalence,increaseandhealthconsequences.Concomitantwiththeincreaseinfoodbornediseases,theHazardAnalysisandCriticalControlPoint(HA-CCP)system,asanewmethodoffoodsafetyassurance,madeitsappearanceinthefoodsafetymanagementsystemoffoodindustries,andasaregulatorytoolinthefoodcontrolsystemsinseveralcountries,inparticularintheindustrializedcountries.TheattentionthattheHACCPsystemhasreceived,bothintheprivateandpublicsectors,hasbeeninrecognitionoftheincreasingimportanceoffoodsafetytopublichealthandeconomicdevelopment(includingpromotionoffoodtrade),theincreasingincidenceoffoodbornediseases,andthead-ditionaladvantagesthatthesystemo󰂀ersoverthetra-ditionalprescriptiveapproach.Forsomeyears,thepublichealthandfoodcontrolauthoritiesworldwidehavepromotedtheconceptofHACCP.Somecountrieshavetakenstepstoincludeitintheirlegislationasamandatoryrequirement.Never-theless,theincidenceoffoodbornediseasescontinuestorise.Therefore,aquestionthatonemayaskiswhethertheincreaseinfoodbornediseasesandtheadvancesintheimplementationofHACCPconstituteaparadoxordemonstrateafailureinthesystem?Thisiscertainlynotthecase.ThehighincidenceandcontinuousincreaseexperiencedinsomecountriesisneitheraparadoxnorafailureintheHACCPsystem.TheparadoxresultsfromamisunderstandingofwhatHACCPisandwhatitisnot,whatitcandotopreventfoodbornediseasesandthefactorsin¯uencingthese.Thispaperreviewsthefactorsin¯uencingtheincreaseinfoodbornediseases,thepotentialoftheHACCPsysteminpreventingfoodborneillnessesandthedeterminantsofitssuccessandfailure.

2.Factorsin¯uencingtheincidenceoffoodbornediseases

Foodbornediseasesareage-olddiseaseswhichhaveoccurredsincethebeginningofhumanhistoryandwillcontinuetotakeplace.Thedramaticincreaseinfoodbornediseasesexperiencedinrecentyearsinsomecountriesisaconsequenceofthein¯uenceofdi󰂀erentfactors,ofteninter-relatedandcomplex,thecontrolofsomeofwhichliesbeyondthecontrolofthepublichealthauthorities.Thesefactorsincludechangesinthe:(a)Foodsupplysystem:·Massproductionanddistribution,leadingtooppor-tunitiesforcontaminationandalsolargerfoodbornediseaseoutbreaks.·Intensiveagricultureandanimalhusbandrypractices,leadingtoincreasedcontaminationofrawfoodstu󰂀sandincreaseduseofpesticidesandveterinarydrugs.·Internationaltradeandimportofpotentiallycontam-inatedfood.·Alongerfoodchainasaresultofurbanization,lead-ingtogreateropportunitiesforcontamination,sur-vivalandgrowth.·Boomingfoodserviceestablishmentswherefoodhandlersdonotnecessarilyhaveanytraininginfoodhygiene.(b)Healthanddemographicsituation,including·Populationgrowth.·Increaseinnumberofvulnerablegroups,e.g.theel-derly,immunocompromisedindividualsandmal-nourishedpersons.·Increaseinnumberofdisplacedpersonsandrefugees,ofteninaconditionofpoorhealthandnutritionasaresultofman-madeornaturaldisasters(e.g.wars,¯oods,earthquakes,etc.).·Rapidurbanization,insomeareaswithouttheneces-sarywatersupplyandsanitationinfrastructure.(c)Socialsituation,behaviourandlifestylesresultingin·Increasedconsumptionoffoodoutsidethehomewithasubsequentincreaseinthenumberoffoodser-viceestablishments.·Increasedtravelandexposuretounsafefood.·Changesinfoodpreparationhabitsasaconsequenceofchangesinfamilystructure.·Povertyandlackofeducation.·Changedsocialandculturalbehaviourleadingtopre-dilectionforcertaintypesofhazardousfood.·Lackoftimeandstrivingforincreasedeconomicpro®ts.326Y.Motarjemi,F.K󰁿󰁡ferstein/FoodControl10(1999)325±333