NARMS International Activities - Comments 3
by Shaohua Zhao, D.V.M., Ph.D.
DR. ZHAO: Good morning. Yesterday, I talked about PulseNet U.S.A., and today I just wanted to briefly talk about PulseNet International Program. PulseNet was established in 1996, --- that time just --- U.S. Now, we have PulseNet Canada, PulseNet Euro, PulseNet Asia Pacific, and a PulseNet Latin America.
PulseNet U.S.A., as I mentioned yesterday, we have over 70 laboratory participants that include --- PulseNet Central, 50 state public health laboratory, and the 12 county and city laboratory, two USDA laboratories, and the eight FDA laboratories.
PulseNet Canada, they have nine federal and province laboratories. They are one of the earliest countries to join PulseNet, so right now, they have -- just like one of our states, we have daily communications through their web ---, so they are very active participants with PulseNet.
PulseNet Europe, they have 54 institutions from 28 countries. The headquarters is in Denmark, so I think right now, now that they are ---, through the online, PulseNet cannot communicate with --- I don’t know when we will be online communicating with PulseNet and CDC, but they still have lots of --- in structure, you know, internally --- later work.
PulseNet Asia, they have 12 countries and 13 laboratories. So the headquarters is in Hong Kong. So the --- PulseNet has invited scientists from different regions to come to cities, all cities. All cities --- they also send the people in Hong Kong and the training in the Hong Kong.
PulseNet Latin America, they have 13 countries. I think PulseNet has cities they send the scientists, they train in Argentina. Argentina is their headquarter.
I think I want to give an example here about the PulseNet in Canada. How closely they are working together to show some of the significance to protect the public health. 1999 PulseNet Canada, they have some non- --- due to the dog treats. So they have the same pattern as the U.S., but we do not have the pattern made. The same pattern, but because there is --- dog treats, CVM has regulated those --- or dog treats.
So the same --- is a program. So we do have isolates and multi-drug resistant, some --- from the domestic or the imported food from Canada. Found out the same, there is non- --- contaminated with dog treats. So FDA said to publish a warning to the nationwide to be aware of the problem.
So that is the example how successful --- with another country’s problem, but we take the action to protect the public and the U.S.
So why should PulseNet go to the international? I think pattern, the team pretty much covers what I said here. You know, because we live in the global community, and the food produced --- part of the --- consumed in another part of the world. Diseases transmitted through the food should be addressed as a global problem and that is why we need effective global early warning system. And the global --- worker and the communication will allow us to utilize the scarce public health resources effectively.
And, lastly, I want to give another example here. Two years ago, Denmark outbreak cipro resistant to Salmonella ---. So because of the global Salmonella program, or PulseNet program, so we have the ---. So this --- to say is anything the U.S. to say that is a PFGE pattern? So we compare, we take the -- this is just an e-mail. So we compare that data fingerprinting to all databases. We look at the domestic. You know, we do have any single isolates to share this exactly same pattern. Because the cipro resistant -- you know, Salmonella is, I think, very low in this country.
So, however, we look at it as an importer for the isolates. We have collaboration with FDA field laboratory. They service imported food to look at the Salmonella isolates. So we do the DNA fingerprinting, and there we compare this importer for the isolates. --- have exactly the same PFGE pattern.
An interestingly, --- is also the cipro resistance. So we e-mail back and say -- they say that they found a dose of cipro --- is isolated from imported Thai chicken from Thailand. So we look at the back-up to our data, those isolates are also from Thailand too, but it is from a safe food. You know, it is interesting, we don’t know exactly how the chicken farmer, or fisherman, how close they are to each other. Or I know some Asian countries use chicken feces to feed the fish in ponds.
But, anyway, maybe that is kind of to let us know how the Asian countries -- how the --- use as an animal environment. It is very effective to know this can be just a global problem.
So I think a leverage is the network to respond to other emerging infectious diseases or acts of bio-terrorism. Thank you.
DR. YOUNGMAN: Are there any questions about the international issues related to NARMS?
DR. KOTARSKI: Yes, I had one question. When we looked at the NARMS budget yesterday, what percent of the NARMS budget is attributable to these activities?
DR. WALKER: $101,000.00 goes to the WHO Salm-Surv.
DR. YOUNGMAN: So that is in addition to that money that is divided for that, we also supply trainers to go for two weeks at a time to provide training sessions.
DR. KOTARSKI: Was that in the budget that we saw in yesterday’s budget?
DR. YOUNGMAN: It was, yes.
DR. KOTARSKI: Oh, okay.
DR. YOUNGMAN: There was a line-item for $101,000.00.
DR. WALKER: Right.
DR. KOTARSKI: Okay, thank you.
DR. YOUNGMAN: In 2005. Each year, it is a different amount depending upon our appropriated dollars.
DR. MILLER: But $100,000.00 is not the same as the personnel.
DR. YOUNGMAN: No. The personnel is in addition to the $101,000.00.
DR. MILLER: And that is not in the budget.
DR. YOUNGMAN: That is not in the budget, no.
DR. KOTARSKI: I had another question. I think it is very impressive that you can link up all these isolates across the world. It is very impressive.
Did I understand correctly that we get chicken imported from Thailand as part of our meat supply? Did I misunderstand?
DR. ZHAO: No, that is in Denmark. Denmark gets chicken imported from Thailand. But we, our field laboratory inspectors are mostly safe food import. Imported from Asian countries. So the ---. You know, imported chicken in Denmark, and we --- from Thailand ---.
DR. KOTARSKI: And just a general question. From what you have learned so far, do you see regional-specific serotypes and pattern?
DR. YOUNGMAN: I am not certain ---.
DR. KOTARSKI: Yes. But do you expect to see very different PFGE patterns across different parts of the world? So when you do see a match you say, ah, we didn’t expect to see anything.
DR. ZHAO: So far, we only did it at two years of research. This was imported through the isolate. In general, they are a very different pattern. But a --- is exceptional. You know, because --- which country --- a pattern. But in another --- type, there are general bridging from what we see in this country.
DR. CHILLER: And I will answer that too. In Global Salm-Surv we work really hard initially to try to get people to serotype Salmonella. And so we have a pretty good idea now internationally about where serotypes are occurring. And there clearly are differences, and it is exciting to see those differences.
At the same time, we have also been able to use these serotype differences to identify outbreaks, as sort of Shaohua is saying. If we are seeing -- just to give you an example, we had a Salmonella wealth of raden -- which is a rather rare serotype in this country -- outbreak in a prison in this country.
We know Salmonella waltaraden is the most common serotype in Asia. So immediately, because of that knowledge, we were able to think. Well, maybe there is something being imported from Asia. Maybe it is homegrown, but certainly we were thinking what things. And we know waltraraden is very much associated with seafood in Asia. So, immediately, it went toward that sort of hypothesis, helping us generate the investigation. And, I think, at the end of the day, we implicated tuna from the Phillippines.
But yes, there are ways that we can already show that this kind of data and information is helping us here locally. And, yes, when you do see matches, even in a serotype, it can be very, very helpful in performing an investigation and understanding epidemiology. So you don’t even need to even go to pulse field. Although, pulse field has helped us identify chocolate outbreaks, for example. German chocolate being imported in the United States, pulse field gels were matching on that.
So it can be very, very helpful, but sometimes you don’t even need to take it to that level.
DR. YOUNGMAN: Thank you. Yes?
DR. AIDARA-KANE: It is not a question, it is a comment from WHO. I would just like to express our gratitude to NARMS and all of our partners who are working hard to sustain Global Salm-Surv, because it is really a great program. It is amazing to see how we are successful in building capacity inter-laps in developing countries. And what is most important is to see people from the same country coming to Global Salm-Surv.
Epidemiologist and microbiologists, who they don’t know each other, who were not able to share information. And only the fact that they meet and share information through Global Salm-Surv training process make them start something on several of foodborne diseases into their countries. It is really a great program and I would like to thank all of the partners. NARMS -- CDC is working very hard on this program, and is really the force that is behind WHO. The main --- falls behind WHO and I would like to thank all the partners of Global Salm-Surv on behalf of WHO.
DR. YOUNGMAN: Thank you very much. Are there other comments about international?
DR. ALTEKRUSE: I have a question. Some of the partners, especially, developing nations, what are sources of funding that they are identifying to get their projects off the ground?
DR. CHILLER: There is a lot. A lot of different sources of funding. Some of them are reaching to the World Bank, for example. I mean, I will start at the big level. Some people are reaching out for funds to the World Bank. Brazil has a very big amount of money from the World Bank that has been given to their ministry of health. And the ministry then decides how they want to spend it. And they have decided that foodborne disease surveillance, Salmonella surveillance, is important.
It turns out that salmonellosis in Brazil is a huge, huge problem; yet, they don’t serotype. So they don’t really know where it is coming from. So they are very excited about getting serotyping going down in Brazil. They have decided to dedicate some of those World Bank funds; which, of course, is a loan that they get which they have to eventually pay back. They have to decide. They have decided to dedicate that to Global Salm-Surv training in capacity building in foodborne disease surveillance.
So that is just a big example. There are then funding organizations like JICA, from Japan. Japanese International Cooperation Agency that has funded, and co-funded some activities in Asia. Then there are local sources of funding that we help partners go after and try to help them identify. Or they may identify with us a local source of funding that we can help them tap into.
I think as Pat mentioned, these international activities, although both FDA and CDC have given about $100,000.00 each year to Global Salm-Surv that goes up to WHO -- that, obviously, not a lot of money, you can run two training courses.
So I think we all do a lot of -- I think we all volunteer a lot, I think we all try to be as creative as we can in funding. And we are constantly looking out at new opportunities and new possibilities; including, USDA that does a lot of -- they have, obviously, educational grants that they give. So we are constantly looking for new sources.
So I think we sort of have three ways we approach the global way. Like the Gates Foundation, World Bank. Sort of a national way, through donor countries, like the U.S. and Canada. And Australia has given some money. And then, actually, there are some funds within certain countries that you can tap into.
DR. YOUNGMAN: Any other comments on international issues for NARMS?
DR. YOUNGMAN: Okay, the next thing on our agenda is to talk a little bit about funding. And Dr. Stephen Sundlof, who is our Director of the Center of Veterinary Medicine -- of which NARMS is, obviously, a part -- has said he would say a few words about NARMS funding. He is here with us today. I don’t think he has slides.
DR. SUNDLOF: No.
DR. YOUNGMAN: Okay. Thank you.