Roteiro para Elaboração de Ato Normativo para a Categorização dos Serviços de Alimentação Prático / Script for the Elaboration of a Normative Act for the Categorization of Practical Food Services

A Categorização dos serviços de alimentação possibilita que os consumidores escolham os serviços de alimentação que se preocupam com a qualidade sanitária. A Agência Nacional de Vigilância Sanitária (Anvisa) decidiu criar um sistema semelhante para os serviços de alimentação no Brasil. Este sistema teve a preocupação de minimizar o risco para Doenças Transmitidas por Alimentos (DTA). Para o projeto-piloto de Categorização da Copa do Mundo FIFA® em 2014, foi desenvolvido um instrumento chamado de lista de avaliação. Esta lista tem como base a RDC nº216/2004 e dos 177 itens de verificação ficaram 51 itens de verificação com foco no risco sanitário para DTA. Esta lista foi aplicada na avaliação dos serviços de alimentação, de forma voluntária, em 11 cidades-sede dos jogos da Copa do Mundo FIFA®/2014. Para realizar a Categorização dos serviços de alimentação, como um projeto de governo, faz-se necessário um ato normativo que oficialize e oriente não somente a adesão a Categorização, mas todas as etapas de sua implantação. Este roteiro não tem caráter normativo e sim orientativo. As informações nele contidas são proposições com a finalidade de orientar e subsidiar estados e municípios na atuação regulatória para a Categorização de serviços de alimentação, podendo ser utilizado na íntegra ou parcialmente.

Ordenha de Leite Humano: procedimentos higiênicos sanitários / Breast Milk Expression: hygienic procedures sanitary

Esta Norma Técnica tem por objetivo estabelecer as condições higiênico sanitárias a serem observadas na realização da extração do leite humano, no domicílio, em Bancos de Leite Humano e em Postos de Coleta de Leite Humano, visando a garantia da qualidade nestes serviços e sua certificação.

Enhancing the value of meat inspection records for broiler health and welfare surveillance: longitudinal detection of relational patterns.

BACKGROUND: Abattoir data are under-used for surveillance. Nationwide surveillance could benefit from using data on meat inspection findings, but several limitations need to be overcome. At the producer level, interpretation of meat inspection findings is a notable opportunity for surveillance with relevance to animal health and welfare. In this study, we propose that discovery and monitoring of relational patterns between condemnation conditions co-present in broiler batches at meat inspection can provide valuable information for surveillance of farmed animal health and welfare. RESULTS: Great Britain (GB)-based integrator meat inspection records for 14,045 broiler batches slaughtered in nine, four monthly intervals were assessed for the presence of surveillance indicators relevant to broiler health and welfare. K-means and correlation-based hierarchical clustering, and association rules analyses were performed to identify relational patterns in the data. Incidence of condemnation showed seasonal and temporal variation, which was detected by association rules analysis. Syndrome-related and non-specific relational patterns were detected in some months of meat inspection records. A potentially syndromic cluster was identified in May 2016 consisting of infection-related conditions: pericarditis, perihepatitis, peritonitis, and abnormal colour. Non-specific trends were identified in some months as an unusual combination of condemnation reasons in broiler batches. CONCLUSIONS: We conclude that the detection of relational patterns in meat inspection records could provide producer-level surveillance indicators with relevance to broiler chicken health and welfare.

Alimentos para usos médicos especiales en la Unión Europea: una actualización legislativa incompleta / Foods for special medical purposes in the European Union: an incomplete legislative update

Este artículo analiza el desarrollo, desde 1989 hasta 2019, de la legislación de la Unión Europea sobre los alimentos para usos médicos especiales dirigidos a pacientes y examina cómo desde 1997 los organismos científicos competentes de la Unión Europea y de los Estados Unidos de América han establecido valores de referencia de la dieta, así como niveles de ingesta superior tolerable para vitaminas y minerales basados en su seguridad. La actualización, mediante el Reglamento (UE) 2016/128, de la legislación de la Unión Europea de esta categoría de alimentos parece adecuada en el caso de los lactantes. Sin embargo, para los pacientes mayores de un año, los mínimos y máximos de vitaminas y minerales por 100 kcal de la Directiva 1999/21/CE no fueron modificados en este Reglamento, ignorando así los valores de referencia de la dieta y los niveles de ingesta superior tolerable del periodo 1997-2015, establecidos ambos por los citados organismos científicos

This article analyses, from 1989 until 2019, the development of the European Union legislation on food for special medical purposes, aimed at patients, and examines how from 1997 the competent scientific bodies of the European Union and the United States of America have established dietary reference values, as well as tolerable upper intake levels for vitamins and minerals based on their safety. The update, through the Regulation (EU) 2016/128, of the European Union legislation on this food category seems appropriate in the case of infants. However, for patients older than one year, the minimums and maximums of vitamins and minerals per 100 kcal from the Directive 1999/21/EC were not modified in this Regulation, thus ignoring the dietary reference values and the tolerable upper intake levels from the period 1997-2015, both established by the aforementioned scientific bodies

Ineffectiveness of meat inspection in the detection of Taenia solium cysticerci in pigs slaughtered at two abattoirs in the Eastern Cape Province of South Africa.

Porcine and human cysticercosis, caused by the larval stage of tapeworm Taenia solium, is a zoonosis in southern Africa and known to be endemic in South Africa, mainly in Eastern Cape Province. No efforts to control or eradicate this parasite have been made, despite the increasing occurrence in most Eastern Cape districts, except for routine meat inspection at local abattoirs. The parasite poses a potentially serious agricultural problem, public health risk and economic loss amongst Eastern Cape smallholder pig production communities. The objective of this study was to determine the effectiveness of routine meat inspection for the detection of porcine cysticercosis in pigs from rural smallholder/subsistence production systems in Eastern Cape Province villages. The effectiveness of meat inspection, by registered meat inspectors, in the detection of pigs infected with T. solium cysts was assessed and compared with whole carcass dissection as the "gold standard" method. The commercial antigen enzyme linked immunosorbent assay (B158/B160 Ag-ELISA) kit screened all the slaughtered animals. The proportion of pigs found infected with T. solium cysts, as measured by meat inspection, was lower (5%, 9/180) than with carcass dissection (18.9%, 34/180) and B158/B60 Ag-ELISA test (21.6%, 38/176). Four out of 180 carcasses were heavily infested with T. solium cysts, evenly distributed throughout the carcasses, to a level impossible to enumerate. Of the remaining 176 carcasses, approximately 526 cysticerci, distributed at various anatomical regions of the pig, were counted during carcass dissection. Sites with higher cyst counts, such as the back and hind leg, do not form part of the normal meat inspection regime. The level of agreement (Kappa statistic) between dissection (gold standard) and meat inspection of the two districts was negative (-0.1955). There was a slight agreement in the Kappa statistic (0.0328) between dissection and B158/B60 Ag-ELISA. This study confirms that current meat inspection procedures alone are not sufficiently sensitive to detect all cases of porcine cysticercosis at the abattoirs and require modifications, or should be supplemented by other methods. A risk-based meat safety assurance system, such as HACCP, that considers specific food safety aspects before and after the abattoir (point of slaughter) should be followed. Before slaughter, aspects such as origin, husbandry practices and on-farm animal health control should be considered; after slaughter, the abattoir should inform the next entity in the supply chain of the limitations of meat inspections and the real meaning of an "Approval" stamp. New validated testing methods that can be routinely used should be developed, and government should develop policies and legislation that promotes a risk-based meat safety assurance system throughout the food supply chain.

Source attribution at the food sub-product level for the development of the Canadian Food Inspection Agency risk assessment model.

Decreasing the health burden caused by foodborne pathogens is challenging and it depends on the identification of the most significant hazards and food sources causing illnesses, so adequate mitigation strategies can be implemented. In this regard, the Canadian Food Inspection Agency (CFIA) has developed the Establishment-based Risk Assessment (ERA) model, so that a more effective and efficient allocation of resources can be assigned to the highest food safety risk areas. To assess risk, the model considers the type of food sub-products being manufactured by establishments and its scope is limited to the 17 most important foodborne pathogens representing the highest level of food safety risk. However, the information on source attribution at the sub-product level based on a structured approach is limited. To overcome this challenge, an expert elicitation was conducted in 2016 to estimate the relative contribution and associated certainty of each sub-product for 31 pathogen-commodity combinations to the total Canadian health burden associated with foodborne illnesses (expressed in DALYs). These DALYs represent 78% of the total Canadian health burden associated with federally-regulated food commodities considered within the model. A total of 49 Canadian experts recruited using a "snow ball" sampling strategy participated in the study by completing an electronic survey. Results of the elicitation displayed variable levels of health burden allocation between the pathogens and the different commodity sub-products. Assessment of the certainty levels showed some combinations being evaluated with more confidence (e.g., Campylobacter and eggs/poultry sub-products) than others, where a bimodal distribution of certainty was observed (e.g., Toxoplasma in pork sub-products). Furthermore, no participant raised concerns on the food classification scheme, suggesting their agreement with the proposed sub-products categorization of the elicitation. Relative contribution estimates will be included in the CFIA ERA model and used to enhance its applicability for risk prioritization and effective resource allocation during food establishment inspections. While substantial uncertainty around the central tendency estimates was found, these estimates provide a good basis for regulatory oversight and public health policy.

Bacterial content and characterization of antibiotic resistant Staphylococcus aureus in Danish sushi products and association with food inspector rankings.

This study examined the prevalence and phenotypic and genotypic antibiotic resistance patterns of Staphylococcus aureus in sushi from 20 Danish outlets. Microbial quality of sushi products and food inspector ranking of outlets were assessed and results for thirteen of the outlets were compared with findings from a previous study in 2012. Inspector rankings were similar in the two studies. The mesophilic aerobic counts were slightly lower (p = 0.0296) in 2017 than in 2012 with average values of the 13 shops of 5.2 log CFU/g and 5.7 log CFU/g, respectively. In both studies E. coli was only found in the products from outlets that did not have consistently superior rankings. On the other hand prevalence and average counts of Staphylococcus spp. were slightly higher in 2017 (p = 0.0286) but no methicillin-resistant S. aureus (MRSA) were observed in the present study. Methicillin-sensitive S. aureus (MSSA) were, however, isolated from 18.7% of sushi products with an average count below 2 log CFU/g. Based on spa and multilocus sequence typing (MLST), isolates belonged to clonal complex CC7 (t2016), CC20 (t7836), CC45 (t065, t127, t362), CC88 (t1998) and CC398 (t164, t331, t1451). The Panton-Valentine leukocidin (PVL)-encoding gene lukF was detected only in isolates of the t065 spa-type whereas the scn gene from the ΦSa3 prophage was detected in 76.5% of the isolates, supporting that the majority of isolates were of likely human origin. Thirty-six isolates (70.6%) were resistant to at least one of the antibiotic compounds tested. Antibiotic resistance genes that confer resistance to ß-lactams (blaZ) and macrolides (ermC) were detected in 33.3% and 9.8% of isolates, respectively. The tet(K) gene that encode tetracycline resistance was only found in a t7836 strain. Overall, this study indicates that S. aureus in sushi products in Denmark do not represent a major food safety hazard due to, firstly, the low temperature and limited time of storage of product may prevent significant growth and production of toxic levels of enterotoxin of this species. Secondly, the S. aureus isolates obtained did not include MRSA variants and none of them encoded PVL that constitute one of the virulence factors in pathogenesis. Several MSSA isolates contained however genes encoding antibiotic resistance, which emphasize the potential role of foods as vehicles for transmission of such variants.

Evaluation of the diagnostic sensitivity and specificity of meat inspection for hepatic hydatid disease in beef cattle in an Australian abattoir.

Hydatid disease, caused by Echinococcus granulosus, is a widespread, endemic disease of Australian livestock, wildlife, and occasionally, humans. In the Australian beef industry, the disease is believed to have a substantial economic impact. The reference standard test (gold standard) for detection of hepatic hydatid cysts is gross identification of cysts following cutting of livers into 5-6 mm slices with histological identification in the case of equivocal cysts. This test is not feasible in abattoirs because it takes too long, destroys inspected livers which have monetary value, and could require laboratory facilities. Therefore, routine meat inspection in abattoirs comprises visualisation of the organ surface and palpation to detect hydatid cysts. In this study, we aimed to evaluate the diagnostic sensitivity and specificity of current routine meat inspection processes in an abattoir to detect hepatic hydatid disease (the index test) in comparison to the reference standard test. Both the index and reference standard tests were performed on a systematic random sample of 636 livers from 5023 cattle slaughtered during the study period. Relative proportions of the true positives and false negatives were calculated for categories age, sex, feed-type (grass- or grain-fed), number of cysts, and size of cysts. Pearson's Chi-squared analyses were used to assess the significance of these proportions. Relative diagnostic sensitivity and specificity of the index test were determined whilst accounting for the sampling fraction. The relative proportion of true positives to false negatives in livers with one cyst (True Positives [TP] = 30.2%) was significantly lower than in livers with 2-5 cysts (TP = 59.2%; P < 0.05), and livers with more than ten cysts (TP = 75%; P < 0.001). The diagnostic sensitivity and specificity of the index test was 24.9% (95% Confidence Interval [CI] 18.9-32.3) and 98.9% (95% CI 97.6-99.6), respectively. The high specificity demonstrates that truly uninfected livers are generally correctly reported. However, the low sensitivity of the index test indicates that prevalence reported by the focus abattoir is underestimated. Although the intended use of routine meat inspection for hydatid disease - to remove "unwholesome" meat from the line of human consumption - is conducted, the results of this study demonstrate that the prevalence of E. granulosus might be higher than reported in abattoir data.

Spatio-temporal patterns and characteristics of swine shipments in the U.S. based on Interstate Certificates of Veterinary Inspection.

Domestic swine production in the United States is a critical economic and food security industry, yet there is currently no large-scale quantitative assessment of swine shipments available to support risk assessments. In this study, we provide a national-level characterization of the swine industry by quantifying the demographic (i.e. age, sex) patterns, spatio-temporal patterns, and the production diversity within swine shipments. We characterize annual networks of swine shipments using a 30% stratified sample of Interstate Certificates of Veterinary Inspection (ICVI), which are required for the interstate movement of agricultural animals. We used ICVIs in 2010 and 2011 from eight states that represent 36% of swine operations and 63% of the U.S. swine industry. Our analyses reflect an integrated and spatially structured industry with high levels of spatial heterogeneity. Most shipments carried young swine for feeding or breeding purposes and carried a median of 330 head (range: 1-6,500). Geographically, most shipments went to and were shipped from Iowa, Minnesota, and Nebraska. This work, therefore, suggests that although the swine industry is variable in terms of its size and type of swine, counties in states historically known for breeding and feeding operations are consistently more central to the shipment network.

Identification and classification of sampling sites for pathogen environmental monitoring programs for Listeria monocytogenes: Results from an expert elicitation.

Pathogen Environmental Monitoring (PEM) programs for Listeria are important to reduce the contamination risk for exposed Ready-To-Eat (RTE) food products with L. monocytogenes. Specific guidance to identify appropriate sampling sites in individual facilities, including equipment and other sites, will facilitate effective L. monocytogenes control and PEM programs. Key goals of Listeria PEM programs are to (i) identify and eliminate niches that allow for Listeria growth and survival and (ii) verify and validate preventive controls such as sanitation programs and sanitation standard operating procedures (SSOPs), sanitary equipment and facility design. Here, an initial list of 77 sampling sites covering Zones 1-4 was assembled based on current literature and guidance documents with initial classification of sites into (i) Zones 1, 2, 3, and 4; (ii) likely niches or transfer sites, and (iii) verification sites or indicator sites. An expert elicitation that included responses from 16 food safety professionals was used to (i) refine sampling site descriptions and identify 6 new sampling sites that were not included in the original list, (ii) refine classification of sites (e.g., into niches versus transfer sites), and (iii) rank sites on level of importance from 1 to 5. The final sample site list includes sampling sites classified by zone and type of site as well as relative importance of site based on reviewer feedback. This document thus provides an initial set of sites that can be used by industry to help in the development or refinement of Listeria PEM programs. The availability of this ranked list of sampling sites should reduce barriers to development of science based Listeria PEM programs.

Selection of risk factors to be included in the Canadian Food Inspection Agency risk assessment inspection model for food establishments.

The Canadian Food Inspection Agency (CFIA) is developing a risk assessment model for food establishments. Previous research on the significance of food safety risk factors determined by literature review and expert advice served as the bases for the current study, to further refine, discriminate and select the most important criteria to be included in the model. This process considered the availability of data sources, the clarity and measurability of the selected factors, undertook the elimination of lower-rated risk factors and grouped those with similar focus of attention, enabling the selection of a final list of risk factors for the model. A method of assessment for the remaining factors was then proposed to allow the quantification of individual risk factors within the model. From the 155 risk factors initially identified, 17 consolidated factors were kept and will be considered for the development of the risk assessment model.

[Control of antimicrobial resistance in the food chain: a narrative review]. / Contrasto all'antibiotico-resistenza nella catena alimentare: una revisione narrativa.

A poor environmental management and the deterioration of health and hygiene conditions (lack of awareness and attention to hygienic standards, to measures for preventing transmission of infection, and to appropriate use of antimicrobial therapies) facilitate the selection, release and diffusion of resistant pathogens in the environment, which can very easily contaminate the food chain. Antimicrobial resistance is a major problem worldwide, involving many sectors: medicine, veterinary medicine, breeding, agriculture, economy and commerce. In addition, the expanding globalization and increasing movements of both goods and people across countries and continents have drastically exacerbated the situation. In this difficult context, professionals of both the food and health sectors have an important role to play and their active participation is essential, together with that of citizens and patients themselves. For this very reason, national programs to combat antimicrobial resistance are needed, with a special focus on surveillance, antimicrobial stewardship, training of professionals and citizens, all the while assuring the availability of economic resources to achieve these goals. The "One Health" initiative is intended to strengthen the link between different scientific disciplines, such as human and veterinary medicine, since the phenomenon of antimicrobial resistance may be further aggravated by microbial transmission from animals to humans, directly or indirectly through the consumption of food. The aim of this narrative review is to give an overview of what is known about antimicrobial resistance related to food chain, to illustrate its extent and epidemiology in Italy, in Europe and globally, and to discuss the measures required to fight antimicrobial resistance including good practices on the use of antibiotics.

Short-Form Audit Instrument for Assessing Corner Store Healthfulness.

PURPOSE: To develop a valid and feasible short-form corner store audit tool (SCAT) that could be used in-store or over the phone to capture the healthfulness of corner stores. DESIGN: Nonexperimental. SETTING: Four New Jersey cities. SUBJECTS: Random selection of 229 and 96 corner stores in rounds 1 and 2, respectively. MEASURES: An adapted version of the Nutrition Environment Measures Survey for Corner Stores (NEMS-CS) was used to conduct in-store audits. The 7-item SCAT was developed and used for round 2 phone audits. ANALYSIS: Exploratory factor analysis and item response theory were used to develop the SCAT. RESULTS: The SCAT was highly correlated with the adapted NEMS-CS ( r = .79). Short-form corner store audit tool scores placed stores in the same healthfulness categories as did the adapted NEMS-CS in 88% of the cases. Phone response matches indicated that store owners did not distinguish between 2% and low-fat milk and tended to round up the fruit and vegetable count to 5 if they had fewer varieties. CONCLUSION: The SCAT discriminates between higher versus lower healthfulness scores of corner stores and is feasible for use as a phone audit tool.

Determination of Salbutamol Residues in Goat Various Tissues After Exposure to Growth-promoting Doses.

In order to monitor salbutamol (SAL) use in goats as a repartitioning, we determined SAL residues in various tissues of goats after repeated oral SAL administration at a dose of 0.15 mg/kg daily for 21 days. SAL concentrations were measured by ultra performance liquid chromatography tandem mass spectrometry in extracts of tissues from goats sacrificed 0.25, 1, 3, 7, 14, 21 and 28 days after the last dose. Our results showed that on Day 0.25 of the withdrawal period, the residual proportions of SAL (expressed as percentage) in liver, kidney, lung, hair, stomachs and muscle were 19.5%, 15.3%, 3.3%, 9.6%, 28.2% and 0.8%, respectively. As the withdrawal time increased, the SAL concentrations in most tissues (except hair) decreased rapidly over the first 3 days and more slowly in the following 25 days. After a 28-day withdrawal period, hair, lung, muscle, liver, fat, eyes, rumen, kidney and abomasum still contained ~32.3%, 15.3%, 7.1%, 6.5%, 5.6%, 1.5%, 0.8% and 0.5% compared to the initial residual concentrations determined on Day 0.25, respectively. On withdrawal Day 28, the highest concentrations of SAL were found in hair (16.58 ± 9.48 µg/kg), followed by liver (7.01 ± 0.94 µg/kg), lung (2.81 ± 1.23 µg/kg), kidney (0.64 ± 0.56 µg/kg), whereas the concentrations in other tissues were lower than limit of quantification (0.50 µg/kg). SAL residues were not detected in bile, plasma and brain on Days 7, 7 and 3 after discontinuation of dosing. These findings indicated that the distribution and depletion rates of SAL differed between tissues. It should be noted that SAL residues in stomach were higher than those in muscles during the early withdrawal. We conclude that hair is the preferred tissue to monitor the administration of SAL to living goats, whereas liver can be used to monitor SAL in the carcass for determination of compliance with food safety regulation.

Food Safety Program Performance Assessment in Tennessee, 2003-2011.

To assess food safety program performance, the Tennessee Department of Health conducted food service surveys of randomly selected establishments and reviewed routine inspection reports by environmental health specialists (EHSs) of the same facilities. The individual restaurant sanitation scores, along with types and frequencies of violations noted by the survey team, were compared with records from the previous year. In addition, EHSs were observed as they each performed two routine inspections. Survey team staff consistently marked more critical violations than did field EHS staff. Differences between survey teams and field EHS staff in marking critical violations were statistically significant for all 10 critical violations in the first review cycle, 8 in the second cycle, and 7 in the third cycle. Over the course of the review period, there was a small but measurable improvement in scoring by field EHS staff. Marking of critical violations increased, sanitation scores decreased, and discrepancies with survey teams in both areas decreased.

Consumer Perception of the Food and Drug Administration's Newest Recommended Food Facility Inspection Format: Words Matter.

The Food and Drug Administration recommended restaurant inspection scores change to a format that incorporated three new categories of violations: priority, priority foundation, and core. It was uncertain whether interested consumers would value the more in-depth information or become more confused. The purpose of this study was to assess consumer perception of the recommended inspection system. Data were collected from an online survey. Results showed that consumers want convenient access to the information either online or on the wall of restaurants, and some consumers do want to read inspection reports and use them in making dining decisions. Choice of restaurant inspection format did appear to change consumer understanding and perceptions about some of the violations. Results also demonstrated the importance of the words used to categorize violations.

Inspector Perceptions of the Food and Drug Administration's Newest Recommended Food Facility Inspection Format: Training Matters.

The Food and Drug Administration publishes the Food Code to guide restaurant inspections. The most recent version proposes a three-tier system categorizing violations as priority, priority foundation, and core. This study used a scenario-based questionnaire to examine inspector perceptions and preferences for inspection formats. Results suggest that inspectors would be able to maintain consistent evaluations when changing to the three-tier system, although the classifying terms under the three-tier system were confusing. Additionally, inspectors were not very positive about the new system; they were concerned that the new system would not be easy to understand and use, inspections would take a longer time, it would not accurately reflect the amount of risk associated with violations, and it would not be easy for consumers and managers to understand and use. The results suggest the need for additional training for inspectors before adoption, especially on the rationale and benefits of changing to a three-tier system.