Assessing health benefits of controlling Campylobacter in the food chain.
Date: 2009-07-28
Institutions: European Food Safety Authority
Subjects: European Food Safety Authority, health risk, poultrymeat, public health

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ASSESSING 
HEALTH BENEFITS 
OF CONTROLLING 
CAMPYLOBACTER 
IN THE FOOD CHAIN

Largo N. Palli 5/A 
I-43121 Parma 
Italy
Tel: +39 0521 036 111
Fax: +39 0521 036 110
www.efsa.europa.eu

4-5 December 2008, Rome, Italy

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
EFSA Scientifi c Colloquium 
Summary Report

12

ASSESSING HEALTH 
BENEFITS OF 
CONTROLLING 
CAMPYLOBACTER 
IN THE FOOD CHAIN

4-5 December 2008, Rome, Italy

© European Food Safety Authority – June 2009

Reproduction is authorised, provided the source is acknowledged, save where otherwise stated.

The  views  or  positions  expressed  in  this  publication  do  not  necessarily  represent  in  legal  terms 
the offi  cial position of the European Food Safety Authority. The European Food Safety Authority 
assumes no responsibility or liability for any errors or inaccuracies that may appear.

ISBN: 978-92-9199-134-1
doi: 10.2805/11912

4.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

About EFSA

The European Food Safety Authority (EFSA) was established and funded by the European 
Community  as  an  independent  agency  in  2002  following  a  series  of  food  scares  that 
caused  the  European  public  to  voice  concerns  about  food  safety  and  the  ability  of 
regulatory authorities to fully protect consumers.

In  close  collaboration  with  national  authorities  and  in  open  consultation  with  its 
stakeholders,  EFSA  provides  objective  scientifi c  advice  on  all  matters  with  a  direct  or 
indirect impact on food and feed safety, including animal health and welfare and plant 
protection. EFSA is also consulted on nutrition in relation to Community legislation.

EFSA’s  work  falls  into  two  areas:  risk  assessment  and  risk  communication.  In  particular, 
EFSA’s risk assessments provide risk managers (EU institutions with political accountability, 
i.e. the European Commission, European Parliament and Council) with a sound scientifi c 
basis  for  defi ning  policy-driven  legislative  or  regulatory  measures  required  to  ensure  a 
high level of consumer protection with regards to food and feed safety.

EFSA communicates to the public in an open and transparent way on all matters within its 
remit. Collection and analysis of scientifi c data, identifi cation of emerging risks and scientifi c 
support  to  the  Commission,  particularly  in  case  of  a  food  crisis,  are  also  part  of  EFSA’s 
mandate, as laid down in the founding Regulation (EC) No 178/2002 of 28 January 2002.

For more information about EFSA, please contact:

European Food Safety Authority
Largo N. Palli 5/A
I-43121 Parma
Italy

Tel: +39 0521 036 111
Fax: +39 0521 036 110
www.efsa.europa.eu

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

5.

6.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

CONTENTS

I 

II 

INTRODUCTION 

REPORTS FROM DISCUSSION GROUPS  
DG1: Health impact and attribution of Campylobacter 
DG2:  Quantitative risk assessment of Campylobacter   

in broiler meat in the EU 

DG3: Fluoroquinolone resistance (FQ) in Campylobacter  
DG4: Assessment of eff ectiveness of control measures in the food chain  

III 

FINAL PLENARY DISCUSSION: 
CONCLUSIONS AND RECOMMENDATIONS 

IV 

REFERENCES 

V 

ANNEXES  
1. Programme 
2. List of participants 
3. Presentations of speakers 

Welcome and introduction to EFSA (Marta Hugas) 
New approaches to source attribution and their role in reducing 
campylobacteriosis notifi cations in New Zealand (Nigel French) 
Campylobacter Risk Assessment in the EU: Past, present and future 
(Maarten Nauta) 
Fluoroquinlone resistant Campylobacter -Epidemiology 
and risk assessment (Frank Aarestrup) 
Measures to control Campylobacter in broilers and broiler meat 
(Hanne Rosenquist) 

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26

39

44

49
53
57
63
65

73

105

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Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

7.

 
4. Presentations of Discussion Groups 

149
151
Introduction to Discussion Groups (Stef Bronzwaer) 
Discussion Group 1 – Health impact and attribution of Campylobacter  157
Discussion Group 2 – Quantitative risk assessment of Campylobacter 
in broiler meat in the EU 
Discussion Group 3 – Fluoroquinolone resistance in Campylobacter 
Discussion Group 4 – Assessment of eff ectiveness of control measures 
in the food chain 

163
171

177

Acknowledgements

EFSA thanks A. Havelaar, J.D. Collins, M. Hugas, T. Robinson, P. Mäkelä, and S. Bronzwaer 
for  their  preparatory  work  as  the  Organising  Committee  and  their  active  roles  in  the 
Colloquium,  as  well  as  D.G.  Newell  for  acting  as  overall  rapporteur  to  the  Colloquium. 
EFSA  would  like  to  thank  also  N.  French,  M.  Nauta,  F.  Aarestrup,  and  H.  Rosenquist  for 
their excellent presentations at the opening session; P. Calistri, M. Uyttendaele, H. Kruse, 
and  J.  Wagenaar  for  having  done  the  challenging  job  as  rapporteur  of  the  discussion 
groups; and K. Mølbak, G. Salvat, and G. Klein for skilfully chairing the discussion groups.

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Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Introduction

I 

INTRODUCTION

The 12th meeting in the EFSA Scientifi c Colloquium Series on “Assessing the Health Benefi ts 
of Controlling Campylobacter in the Food Chain” was held in Rome 4-5 December 2008.

Enteric infections caused by Campylobacter are the most frequently reported zoonoses in 
humans in the EU with an incidence rate of approximately 50 confi rmed cases per 100.000 
population over 17 countries (EFSA, 2009).

The  majority  of  cases  of  campylobacteriosis  are  self-limiting  with  3-5  days  of  acute 
diarrhoea, abdominal pain and fever. However, disease in the very young and elderly can 
be serious and sequelae of infection, such as polyneuropathies, may result in the need for 
hospitalisation. Thus the public health and social consequences of campylobacteriosis are 
signifi cant for the EU. 

Some cases require antimicrobial treatment and the increasing incidence of antimicrobial 
resistance is seen as a potential public health issue.

Epidemiological studies worldwide indicate that campylobacteriosis is largely food-borne 
and that poultry meat is a major source. However, the proportion of illness due to poultry 
meat and the contribution of other potential sources remain unclear.

Campylobacter  can  colonise  the  intestinal  tracts  of  birds  at  high  levels  and  faecal 
contamination  of  poultry  carcasses  can  occur  during  processing.  One  of  the  principal 
routes  of  human  exposure  is  considered  to  be  cross-contamination  from  poultry  meat 
during food preparation in kitchens. Control of Campylobacter in poultry meat is a major 
public health strategy for the prevention of campylobacteriosis.

A substantial proportion of the broiler fl ocks in the EU is colonised with Campylobacter 
and this prevalence appears to vary between Member States and according to season. An 
accurate comparison of prevalence has been diffi  cult because of variations in sampling 
and  testing  methodologies.  A  harmonised  and  standardised  baseline  survey  of  the 
prevalence  and  antimicrobial  resistance  of  Campylobacter  in  broiler  fl ocks  and  broiler 
carcasses in the EU was carried out during 2008 in compliance with the provisions laid 
down by the Commission Decision 2007/516/EC. This survey will provide information on 
the prevalence of Campylobacter in caecal samples and quantitative data on Campylobacter 
contamination on broiler carcasses at slaughter. These data are expected to be available 
by April 2010.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

9.

In  2008  the  European  Commission  sent  a  request  to  EFSA  for  a  scientifi c  opinion  to 
“Quantitatively  update  the  2005  Opinion  related  to  Campylobacter  in  animals  and 
foodstuff s as regards broiler meat production Gallus gallus” (EFSA, 2008a). EFSA assigned 
the  mandate  (EFSA-Q-2008-469)  to  the  BIOHAZ  Panel  to  deliver  a  risk  assessment  by 
2010. 

Specifi cally, the Panel was asked to:

 (cid:2)

 (cid:2)

 (cid:2)

Assess the extent to which meat derived from broilers contributed to human 
campylobacteriosis at the EU level

Identify and rank the possible control options within the broiler meat production 
chain

Propose potential performance objectives and/or targets at diff erent stages of the 
food chain to reduce the prevalence of human campylobacteriosis in the EU caused 
by broiler meat consumption or cross-contamination. 

EFSA  decided  to  organise  this  Scientifi c  Colloquium  and  aimed  to  bring  together 
international expertise, including risk assessors, stakeholders and risk managers, to:

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

Discuss in an open scientifi c debate the current issues and future challenges 
concerning the risk assessment of Campylobacter in the food chain in the EU. 

Focus on best approaches for data collection and quantitative risk assessment within 
the EU, determine its impact on human health, fl uoroquinolone resistance, and 
assess what are likely to be the most eff ective control measures.

Identify what data are needed in order to assess the benefi ts of controlling 
Campylobacter (e.g. impact on human health, disease burden and costs). 

Discuss the risk to human health of fl uoroquinolone resistant 
relation to antimicrobial usage in animal husbandry.

Campylobacter and its 

Identify options to control the prevalence, concentration and distribution of 
Campylobacter infections and contamination throughout the food chain, and 
evaluate the current information on the eff ectiveness of these control options.

10.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Introduction

The Colloquium was attended by about 90 scientists and stakeholders, from 30 countries, 
including the USA and New Zealand, and including representatives from the EC (European 
Commission),  ECDC  (European  Centre  for  Disease  Prevention  and  Control),  EMEA  (the 
European  Medicines  Agency)  and  Member  States.  The  meeting  focused  on  four  inter-
related topics. Each topic was introduced by a keynote speaker, in the opening plenary 
session, presenting the state of knowledge in that area. These presentations included:

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

The source attribution and health impact of 
New Zealand), 

Campylobacter (speaker Prof. N. French, 

Quantitative risk assessment in broiler meat (speaker Dr. M. Nauta, The Netherlands), 

Resistance to fl uoroquinolones  (speaker Prof. A. Aarestrup, Denmark), and 

Eff ective control measures in broiler meat production from farm to fork 
(speaker Dr. H. Rosenquist, Denmark).

A briefi ng note had been circulated to all participants before the Colloquium addressing 
discussion  points  on  these  four  topics.  At  the  meeting  participants  divided  into  four 
discussion  groups  to  deliver  expert  summaries,  addressing  the  discussion  points,  and 
reporting back to the plenary in a fi nal discussion session. 

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

11.

II  REPORTS FROM DISCUSSION GROUPS

DG1:  HEALTH IMPACT AND ATTRIBUTION OF CAMPYLOBACTER

1.  Assess the epidemiological evidence on human campylobacteriosis in the 
EU with a view to identifying the extent of the contribution of foodborne 
infection.

The  results  of  epidemiological  investigations  conducted  both  in  sporadic  cases  of 
gastrointestinal  illness  and  during  outbreaks,  indicate  the  important  contribution  of 
Campylobacter to the burden of bacterial zoonotic illness. In particular, in those countries 
where  a  comprehensive  and  extensive  public  health  surveillance  system  is  in  place, 
Campylobacter is  recognised  as  the  leading  cause  of  bacterial  zoonotic  gastrointestinal 
illness (EFSA, 2007; ECDC, 2008). Furthermore, in many countries, the incidence of reported 
cases has increased since the early 1990s. 

The high level of incidence of campylobacteriosis in humans is also confi rmed by popula-
tion-based studies of gastrointestinal illness, for example in the UK and The Netherlands 
(Wheeler et al., 1999; De Wit et al., 2001). More recently, sero-surveillance studies have con-
fi rmed the high exposure rate to Campylobacter in humans (Ang et al. 2007).

Although human campylobacteriosis has been mainly characterised by the occurrence of 
sporadic cases, a substantial number of foodborne outbreaks caused by Campylobacter in 
the last years is observed in the Community Summary Report on Zoonoses (EFSA, 2007).

2.   Consider the applicability of diff  erent approaches to source attribution for 
human campylobacteriosis in the EU (as described in the BIOHAZ opinion 
“Overview of methods for source attribution for human illness from food 
borne microbiological hazards”).

Diff erent approaches exist for source attribution (EFSA, 2008b) including:

a. 

Microbial sub-typing.
 The Campylobacter population is highly variable and there are 
many  sub-typing  methods  described.  The  selection  of  strains  may  bias  the  data 
available for source attribution due to the selectivity of bacterial culture techniques 
and  sampling  procedures  in  food  animals,  food,  the  environment  and  patients. 
Nonetheless, some typing methods (e.g., multilocus sequence typing, MLST), when 
applied  to  carefully  selected  but  comprehensive  strain  collections,  coupled  with 

12.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Reports from Discussion Groups

modelling  techniques,  have  recently  shown  promising  results  for  Campylobacter 
source attribution (Dingle et al. 2008; Wilson et al. 2008). Further activities are needed 
to refi ne and combine diff erent typing methods (e.g. MLST with PFGE and antimicrobial 
resistance  patterns)  to  identify  the  most  proper  “markers”  for  source  attribution 
purposes,  and  to  refi ne  and  evaluate  statistical  models  able  to  properly  assess  the 
contribution of diff erent sources. In particular, the general applicability of this approach 
needs to be evaluated. Attention should be given to the interpretation of Campylobacter 
strains  isolated  from  the  environment  (e.g.  water  pools,  lakes,  rivers,  soil,  etc.),  but 
probably  originating  from  animal  reservoirs.  A  distinction,  in  fact,  should  be  made 
between  vehicles  of  infection,  like  for  example  recreational  waters,  and  the  animal 
reservoirs as primary (host) sources, which amplify the bacterial population.

 The outcomes of investigations of Campylobacter-outbreaks 
Outbreak investigations.
can  give  useful  information  on  vehicles  and  pathways.  However,  they  cannot  be 
directly used for source attribution studies, because the distribution of sources and 
vehicles for sporadic and outbreak cases are unlikely to be the same (Olson et al., 2008). 
The results of these investigations may give valuable information to better interpret 
the results of attribution studies and provide essential information on the contribution 
of risk factors, such as cross-contamination pathways. Often outbreak investigations 
are  hampered  by  the  diffi  culties  in  obtaining  microbiological  evidence  or  evidence 
from an analytical epidemiologic study of the responsible vehicle(s).

Epidemiological  studies.
  In  many  situations,  case-control  studies  of  sporadic  cases 
have provided useful information (Whittemore, 1983; Coughlin et al., 1994; Staff ord et 
al.,  2007).  However,  they  have  serious  limitations.  In  addition  to  well  known  biases 
such as recall bias and selection bias, a high degree of exposure and illness may also 
limit their applicability to address very common exposures, such as handling or eating 
poultry, as potential risk factors. Furthermore, the interpretation of results of several 
studies  has  been  a  challenge  (e.g.  interpreting  exposure  variables  as  “protective” 
factors  when  an  odds  ratio  below  1  is  obtained).  In  some  cases  the  use  of  spatial 
analysis  methodologies  for  exploring  associate  risk  factors  (e.g.  age  distribution  of 
human  cases)  may  be  of  benefi t  (FDI/236/2005).  In  general,  the  combination  of 
epidemiological  studies  with  microbial  sub-typing  and  modelling  techniques  is 
recommended.

b. 

c. 

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

13.

d. 

e. 

f. 

Comparative  exposure  assessment.
    This  approach  addresses  pathways  taking  into 
account the level of contamination in potential sources (Evers et al., 2008). It has not 
been  applied  broadly  to  Campylobacter.  It  has  serious  limitations  in  predicting  the 
contribution of each source to the burden of human campylobacteriosis, due to the 
uncertainty of the events in the diff erent possible pathways (e.g., cross-contamination 
in the kitchen) and the dose-response relationship. At present, it can be used primarily 
to stimulate the generation of hypotheses.

Expert  opinions.
  Risk  managers  often  base  decisions  on  expert  opinions.  It  can  be 
particularly useful when a rapid opinion or assessment is needed for risk management 
purposes or when data for other source attribution methods is lacking. However, the 
opinions should be based on evidence and be updated as knowledge evolves (Havelaar 
et al., 2008). Since one of the main limitations of using expert opinions is the diffi  culty 
in  merging  diff erent  opinions,  specifi c  techniques  to  “weight”  the  expert  opinions 
exist but have not yet been applied to source attribution.

 The assessment of management interventions should ideally 
Intervention assessment.
be  carried  out  in  the  framework  of  controlled  studies.  However,  when  applied  to 
national  control  measures,  the  main  problem  encountered  is  that  interventions  are 
often not planned in a way that enables a systematic assessment of the eff ects, for 
example, with relevant process measurements or more importantly the measurement 
of  public  health  outcomes.  However,  even  with  “unplanned”  interventions  (and 
“natural  experiments”),  it  is  important  to  carefully  analyse  the  eff ects.  Intervention 
studies should ideally be carried out in pilot areas and with proper controls before the 
extension to a broader scale (e.g., at the national level). If this is feasible, it will permit 
to properly assess the impact of possible mitigation actions on a small scale, before 
their more general application.

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Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Reports from Discussion Groups

3.  Consider data availability and propose additional data collection (special 
studies, surveillance) in humans and in the food chain needed for source 
attribution, taking into account diff  erences between Member States.

The strengthening of public health surveillance systems (case-based reporting of human 
data,  travel  history,  storage  of  randomly  collected  samples)  should  represent  the  fi rst 
option for increasing the quantity and the quality of information available. In addition, it 
is fundamental to strengthen the surveillance and sampling designs in order to generate 
comparable  data  on  human  disease  and  food  contamination,  particularly  at  the  retail 
level (EFSA, 2008c), for their use in exposure assessment studies. Such studies may not 
necessarily be implemented in the whole EU, but “sentinel” representative sites may be 
selected around Europe. It would be important to develop a joint protocol for such in-
depth studies with a combination of strain collection at various sources, information on 
exposures, and collection of clinical isolates at the same geographical sites.

In relation to data available at the food chain level, the main source of data on prevalence 
of  contamination  in  chickens  is  represented  by  the  2008  EU  baseline  study  (EC,  2007). 
Prevalence  data  reported  in  the  Community  Zoonoses  Report  may  represent  useful 
background information, but their use in source attribution studies is limited. These data 
derive mainly from (multi)annual plans performed in the EU Member States and, often, 
the  availability  of  quantitative  data  is  scarce.  In  addition,  the  comparability  of  values 
among Member States is diffi  cult to ascertain.

Isolates from foods and animals are available from some laboratories and they can be the 
source of important additional information. However, the methods and criteria of sample 
collection  and  related  information  are  not  always  known  or  recorded  in  a  standard 
fashion.

Food production and sales data, as well as data on import-export and intra-community 
trade are also available. Nevertheless, the degree of accessibility of these data, and the 
completeness of information, especially regarding products having a local market, should 
be explored. EFSA has initiated some activities to gather data on food consumption at the 
EU level (EFSA, 2008d; EFSA, 2008e).

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

15.

Regarding  the  availability  of  data  at  the  human  level,  information  on  reported  cases  is 
available  in  most  EU  Member  States,  but  often  as  aggregated  data.  Data  generated  by 
case-control studies and outbreak investigation are only available in some Member States. 
Campylobacter  isolates  from  humans  are  also  available,  but  a  systematic  collection  of 
samples is in place in only a few countries.

In relation to promoting additional actions to collect further data, the fi rst priority should 
be to improve the accessibility to the existing data sources, (isolates and samples taken 
during e.g. case-control studies). An overview of the studies and data suited for source 
attribution might be of benefi t.

Finally, a consensus should be reached in the EU on the methods for Campylobacter sub-
typing and for the registration of these data in a global typing database.

4.  Identify possible approaches for establishing the degree of under-

reporting of human cases and discuss their applicability at national 
and EU level.

First  of  all,  a  diff erence  between  under-reporting  and  under-ascertainment  should  be 
made. Under-reporting can be determined by a systematic inventory of reporting practices 
of  existing  diagnostic  laboratories  that  examine  stools  samples  for  Campylobacter spp. 
Under-ascertainment is more diffi  cult to determine. An estimation of the degree of under-
ascertainment may be conducted at each level of the surveillance pyramid (% of persons 
with  acute  gastroenteritis  referring  to  physicians,  %  of  stool  samples  taken,  %  of  false 
negative laboratory results, etc.).

Targeted retrospective or prospective studies (by questionnaires, phone interview, etc.) 
may be conducted, to estimate the burden of diarrhoeal illness and multiplication factors 
by which to multiply incidences as reported through the notifi cation system and to obtain 
a  more  accurate  estimate  of  the  true  disease  incidence.  More  recent  developments  in 
communication technology (SMS, web, etc.) may off er further opportunities for accessing 
a larger population sample.

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Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Reports from Discussion Groups

Sero-epidemiological  studies  may  be  of  benefi t,  in  particular  because  some  of  the 
methodological problems related to information bias aff ecting or infl uencing the above 
mentioned studies, may be overcome. Furthermore, sero-epidemiology is a cost-eff ective 
tool. The main critical point is the knowledge of the disease/infection rate and the nature 
of this relationship. In addition, host factors (immunity, medical history, genetic factors 
and interaction with heterologous strains) may be taken into consideration in the further 
refi nement of this approach.

DG2: QUANTITATIVE RISK ASSESSMENT OF CAMPYLOBACTER IN BROILER 
MEAT IN THE EU

This discussion group considered the following 4 discussion points:

1.  Consider the state-of-the-art of risk assessment of Campylobacter in the 

broiler meat chain. Discuss to what degree diff  erent models have come to 
the same conclusions or appear to be contradictory. Propose 
recommendations for further development of risk assessment models.

2.  Evaluate current available quantitative data on Campylobacter in the 

broiler meat chain as well as on the cross contamination between broiler 
meat and other foods. Identify critical data gaps to support risk assessment 
modelling and validation. 

3.  Consider quantitative insights from current risk assessment models on the 

eff  ectiveness of interventions (such as the importance of reducing numbers 
rather than prevalence, the degree of eff  ectiveness of logistic slaughtering, 
etc.) and evaluate the availability of data to validate such models. Identify 
areas where model results are disputable or at odds with available data 
(e.g. the impact of partial depopulation) and ways forward to address these 
issues.

4.  Consider the applicability of current models to support decision making on 
control options at the European level. Assess in particular the eff  ectiveness 
of interventions across the EU so as to support the setting of targets and/or 
performance objectives. 

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

17.

In  the  last  decade,  several  countries  have  developed  risk  assessment  models  for 
Campylobacter in the broiler meat chain. Overall, the models come to similar conclusions. 
The  risk  assessment  approach  has  emphasized  that  both  the  prevalence  and  the 
concentration  of  bacteria  are  important  to  the  risk  to  public  health  impact  and  in 
assessment  of  the  eff ectiveness  of  interventions.  However,  the  relative  importance  of 
these two factors will be dependant on the stage of the food chain under consideration. 
For example the relationship between risk and prevalence in the fl ocks are less direct than 
the  relationship  between  prevalence  of  Campylobacter  and  risk  later  in  the  food  chain 
(e.g. drumsticks at retail level), and may also be dependent on which processes have been 
considered (e.g. cross-contamination, drip fl uids). 

Consumer  risks  appear  to  be  particularly  associated  with  (relatively  rare)  exposures  to 
high  numbers  of  bacteria.  Although  it  is  a  simplifi cation,  it  might  be  said  that  high 
prevalence  carcass  contamination  with  low  numbers  of  organisms  would  be  preferred 
over  low  prevalence  contamination  with  high  numbers  of  organisms.  However,  the 
importance of high and low bacterial numbers is dependent on the shape of the dose-
response model. 

The risk assessment models indicate cross-contamination as an important factor in the 
transmission  of  Campylobacter  from  broiler  meat.  However,  the  module  on  consumer 
behaviour  may  require  further  revision.  Incorporating  expertise  on  social  sciences  on 
consumer  behaviour  should  be  used  to  fi ne-tune  this  important  module  and  link 
contamination in the food chain to the public health outcome. In some of the models this 
module is limited by only considering cross-contamination and not undercooking. This 
will need to be adapted when considering emerging food items brought to the market, 
such as minced meat and meat preparations of broiler meat. 

In addition, all the risk assessment models utilise the same dose-response model that is 
based  upon  a  limited  data  set  and  fail  to  take  into  account  the  known  variability  of 
Campylobacter at strain level. Although this is not an easy task, further eff ort should be 
focussed  on  the  development  of  better  dose-response  models e.g. based  on  acquiring 
more information from outbreak data or establishment of the dose response curves for 
various strain types (defi ned by MLST or other typing method) with variable epidemiolo-
gical associations in human illness versus attributable sources. Other diffi  culties relate to 
inclusion  of  multiple  exposure,  i.e.  immunity  due  to  repeated  challenge,  in  risk 
characterisation (Havelaar et al., 2009). 

18.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Reports from Discussion Groups

Further developments are expected with regard to the methodology of risk assessment. 
Bayesian modelling, with the ability to update the model estimates and to include prior 
knowledge (to combine observation and expert opinion), might be used as an integrated 
approach with Monte Carlo simulation, in order to use all the information available. If data 
are  available,  it  is  recommended  to  include  variability  on  processing  practices  in  the 
models. Although it is diffi  cult especially if many assumptions are made, the risk assessment 
models should include uncertainty as an important feature in any communication to risk 
managers.

As the input or basis of Campylobacter risk assessments, models often refer to the same 
available  quantitative  data  sets  that  were  derived  from  one  specifi c  situation  in  one 
specifi c country. There is a need to know the variability in the broiler meat chain among 
Member States but also among food business operators (slaughter and further processing) 
within a country. In addition, consumer behaviour diff er between and among Member 
States’ populations. Cultural diff erences, for example, aff ect the consumption patterns of 
the main types of fresh broiler meat and meat preparation; knowledge that is needed to 
compare the risk derived from various types of broiler meat within Europe. 

At present, more quantitative data is becoming available on the occurrence and dynamics 
of  Campylobacter in  the  broiler  meat  chain  as  well  as  on  cross-contamination  between 
broiler meat and other foods. Nevertheless, data gaps are still identifi ed, which relate to 
the quantitative eff ect of technological interventions, and the variability depending upon 
the exact conditions of implementation of such interventions. Of importance is the quality 
of the available data sets in order for them to be a sound basis for risk assessment. For 
example, (i) the need for appropriate detection methods enabling resuscitation of sub-
lethally injured cells, in acquiring presence/absence  or enumeration data of Campylobacter 
in the food chain, especially if evaluating interventions that stress these bacteria, and (ii) 
acquiring data for transfer rates of Campylobacter from naturally-contaminated samples 
or acquiring data on consumer behaviour, using observational studies. The integration of 
new data in risk assessment models and the comparison of model predictions with fi eld 
measurements  has  not  yet  been  extensively  done.  There  is  a  need  for  a  set  of  “Good 
Practices”  on  how  to  treat  the  quantitative  data,  to  take  into  account  measurement 
uncertainty and to turn such data into distributions, especially with regard to handling 
data below the detection limit.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

19.

Current risk assessment models were predominantly developed within individual Member 
States to compare intervention measures or to identify critical data gaps by systematic 
analysis  of  the  broiler  meat  chain.  Occasionally  it  was  also  the  purpose  to  link  the 
contamination and control of Campylobacter in broiler meat to a public health outcome. 

Risk  assessment  contributes  added  value  to  observational  studies  because  it  is 
multidisciplinary,  brings  together  available  data,  integrates  knowledge  in  a  systematic 
manner and is prognostic in nature. Validation of these models establishes whether they 
are  fi t  for  purpose.  If  the  purpose  is  to  put  forward  the  most  promising  options  for 
interventions,  or  identify  lack  of  supporting  data,  the  models  succeed  in  providing 
quantitative insights on the eff ectiveness of interventions and/or the availability of data 
for science-based decision making. Nevertheless, the feasibility of a promising intervention 
measure will subsequently need further pilot studies in selected food business operators 
in  the  broiler  meat  supply  chain,  to  establish  cost/benefi t,  effi  cacy  and  variability  of 
implementation in the fi eld. Quantitative risk assessment by scenario analysis enables a 
targeted approach for data gathering and further testing of intervention measures in fi eld 
trials. The use of (repeated) baseline surveys might be an indirect measure of implemented 
control measures but many (risk) factors interact in the supply chain. Underlying changes/
new  trends  in  production  practices  and  consumer  behaviour  might  intermingle  and 
confuse the eff ect of such intervention measures.

If  the  purpose  of  the  risk  assessment  is  to  estimate  the  risk  to  public  health  due  to 
Campylobacter contamination of broiler meat, validation might be particularly diffi  cult as 
it is necessary to know the contribution of a particular food item (i.e. fresh broiler meat) to 
the burden of disease. Routine surveillance for campylobacteriosis might not be able to 
do this. Validation might only be feasible by setting up targeted epidemiological studies. 

Because of increased awareness about the issue of Campylobacter in broiler meat and its 
eff ect on public health, the food industry needs guidelines or targets in, or at the end of, 
the production chain. It is important that these targets are well communicated, and are 
valid and acceptable for both EU and international food business operators in order to 
assure and improve public health of the European consumer. 

20.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Reports from Discussion Groups

Current risk assessment models concur that reducing the numbers of Campylobacter on 
broiler  meat  will  eff ectively  reduce  campylobacteriosis.  There  are  many  target  setting 
options.  One  target  might  be  that  “X%  of  birds  (caecal  samples)  or  Y%  of  fresh  meat 
(broiler carcass or neck skin or broiler meat at the end of production line) cannot have 
more than Z cfu/g or cm2 (defi ned by the method) at a certain stage of the food chain”. 

If the target is set in the supply chain at a stage close to the consumer, the link to public 
health outcome, as assessed by the models, will be less prone to variability and uncertainty. 
But from a point of view of the food business operator, targets close to the consumer are 
less practical as there is little room for corrective action, especially taking into account 
broiler  meat  being  a  raw  and  perishable  food  item.  If  the  target  is  set  closer  to  the 
beginning of the supply chain, the implementation of eff ective interventions and control 
measures  might  be  more  feasible  but  the  confi dence  level  in  improved  public  health 
might  be  less  because  of  the  variability  in  processes  further  along  the  food  chain. 
Nevertheless, this variability becomes less important for Campylobacter than most other 
bacterial foodborne pathogens as Campylobacter does not grow on food during storage 
and handling.

It should be noted that, even with the same target, outcomes on public health (human 
cases) will vary between countries depending on consumer behaviour and consumption 
patterns.

Models available today are constructed at the national level and do not necessarily cover 
the full “farm” to “fork” supply chain. It is debatable if some assumptions or data sets used 
within  these  models  are  valid  at  an  EU  level.  Quantitative  data  throughout  the  broiler 
meat production chain, and throughout Europe, will help to fi ne-tune the models for risk 
assessment, provide more accurate estimates and contribute to establishing quantitative 
targets.  Particular  research  attention  is  needed  on  i)  the  acquisition  of  microbiological 
data i.e. enumeration of Campylobacter with robust methods and ii) consumer behaviour 
i.e. in relation to food handling and consumption patterns. The next challenge will be to 
integrate  variation  throughout  Europe  and  to  develop  a  generic  model  to  support 
decision-making on control options at the European level or, in particular, to assess the 
eff ectiveness of interventions across the EU. Such information will support the setting of 
targets and/or performance objectives. 

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

21.

The applicability of current models to support decision-making on control options at the 
European level is restricted, thus a pragmatic approach is recommended. The opportunity 
should be taken using the availability of the quantitative data from each Member State, 
from  the  2008  EU-wide  baseline  survey  on  Campylobacter  in  broiler  fl ocks  and  broiler 
carcasses, to initiate setting targets for Campylobacter in the broiler meat chain. The food 
industry must be able to achieve these targets by implementing appropriate Food Safety 
Management Systems. However, it is clear that such strategies will not lead to zero risk of 
campylobacteriosis due to consumption of broiler meat.

DG3: FLUOROQUINOLONE RESISTANCE (FQ) IN CAMPYLOBACTER

1.  Consider the prevalence of FQ-resistance in poultry fl ocks, on carcasses and 

on poultry meat and its relationship to antimicrobial usage in animal 
production.

There  are  some  country  reports  on  the  prevalences  of  FQ  resistance  in  Campylobacter 
from  poultry,  poultry  meat,  humans  (EFSA,  2007).  In  order  to  be  able  to  relate  the 
prevalence of FQ resistance to drug usage, monitoring of both resistance and drug use at 
the  national  levels  is  essential.  Monitoring  of  drug  usage  will  enable  to  follow  trends, 
perform  relevant  risk  assessments,  suggest  interventions,  and  monitor  eff ects  of 
interventions. Several countries have national drug use monitoring systems in place, while 
in many other countries drug use data are known, but not easily accessible. Furthermore, 
data  collection  systems  diff er  considerably  between  countries  (e.g.  based  upon 
prescriptions, sales at species level, or just total sale).

Scientifi c evidence shows that the use of FQ has led to the emergence of FQ resistance 
in  Campylobacter  in  poultry  fl ocks.  However,  the  exact  nature  of  the  relationship,  i.e. 
infl uence  of  high  level  or  low  level  usage,  is  not  known.  Furthermore,  it  is  unknown 
whether strategic use (e.g. only within the fi rst week of life) would lead to less emergence 
of resistance. It is not known what the diff erences are between the diff erent quinolones in 
their ability to select for resistance. There appears to be a correlation between resistance 
levels of bacteria in broilers, on carcasses and on meat. However, the latter is more diffi  cult 
to determine because of the eff ect of cross-contamination and also because meat at retail 
comes from diff erent sources (e.g. imported meat).

22.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Reports from Discussion Groups

The eff ect of withdrawal of FQ is poorly understood. However, expert opinion indicates 
that major interventions (e.g. ban, stringent compliance) on drug usage are necessary to 
halt further increase in resistance, but it is unknown if resistance levels will subsequently 
decrease. The importance of assessing the eff ects of any interventions, such as the ban of 
enrofl oxacin  in  poultry  production  in  the  US  should  be  emphasised.  The  missed 
opportunity in monitoring eff ects on antimicrobial resistance in relation to the recent ban 
on growth promoters was noted.

2.  Evaluate the signifi cance of FQ-resistant Campylobacter on broiler meat 

from a public health perspective. Consider the available evidence and risk 
assessment models to quantify the proportion of FQ-resistant human cases 
attributable to broiler meat.

The  evidence  for  a  signifi cant  or  added  risk  on  public  health  of  FQ-resistance  in 
Campylobacter  is  debatable.  Diff erent  studies/reviews/analyses  have  reached  diff erent 
conclusions as to whether FQ-resistant strains are more hazardous in regard to prolonged 
symptoms (diarrhoea), severity and hospitalization rate. Studies in Denmark and USA have 
found increased risks (Helms et al., 2005; Nelson et al., 2007), whereas a study in the UK 
(Campylobacter Sentinel Surveillance Scheme Collaborators, 2002) did not. A meta-analysis 
of all such studies (Wassenaar et al., 2007) found no association. There are diff erent risks 
for  diff erent  patient  populations,  as  mild  cases  do  not  require  antimicrobial  therapy 
anyway,  and  as  severe  cases  of  diarrhoea  of  unknown  origin  are  normally  treated 
empirically  with  antimicrobials  (generally  a  FQ  if  e.g.  Salmonella  is  suspected).  If  FQ-
resistant  organisms,  including  Campylobacter,  are  present  there  is  increased  risk  of 
treatment failure and adverse outcome. Furthermore, there are indications of increased 
infection rates with FQ-resistant Campylobacter strains in humans that are receiving FQ 
treatment (Helms et al., 2005).

It is considered that the majority of Campylobacter  infections are acquired from broiler 
meat. It therefore seems reasonable to assume that the same is true for infections with 
FQ-resistant Campylobacter. However, sources for Campylobacter (including FQ resistant 
strains)  other  than  broiler  meat,  should  be  taken  into  consideration.  For  instance,  the 
environment and water can be contaminated with Campylobacter due to indirect (faecal) 
contamination from animals (including broilers) and possibly humans. 

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

23.

3.  Consider the possibilities for, and impact of, reducing antimicrobial usage 
in broiler production on the occurrence of resistant Campylobacter on 
broiler meat and the public health impact of such control.

It is assumed that there will be a positive public health impact from reducing FQ use in 
broiler production. It is a fact that FQ-resistance is increasing in Campylobacter isolates 
from both humans and poultry. Studies show that resistance in humans follows the usage 
of FQ in food animals and the build up of resistance among Campylobacter in food animals 
(Endtz et al., 1991; Thwaites and Frost, 1999; Nachamkin et al., 2002). Danish and Norwegian 
studies  showed  that  the  proportion  of  FQ-resistant  Campylobacter  among  domestic 
poultry (low usage of FQ in poultry) and domestically-acquired cases was low, as opposed 
to travel related cases where the proportion of FQ-resistant Campylobacter was very high 
(Helms et al., 2005; Norström et al., 2006).

It appears possible to reduce FQ use in broiler production. A prerequisite is that antibiotics, 
including FQ, are only available by prescription. Prescription for antibiotic use in animal 
production is a requirement in the EU, and such a policy would be commendable in the 
rest of the world. However, there is also the issue of non-compliance and illegal use. Thus, 
enforcement is critical. Some countries have shown that it is possible to produce poultry 
with  limited  or  without  FQ  use,  e.g.  Australia,  New  Zealand  and  the  Nordic  countries. 
Moreover, the US banned FQ in poultry in 2006 in light of public health risks associated 
with such use. There is, however, lack of knowledge of what will be the impact of diff erent 
management options (ban; use only for certain indications; off -label use; use only after 
susceptibility testing, etc.). FQ are slowly degraded in the environment and there is a carry-
over  of  small  quantities  of  FQ  in  the  poultry  environment  (especially  for  FQ  used  in 
water).

24.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Reports from Discussion Groups

4.  Identify critical data gaps and recommend further studies to address these 

data gaps.

The importance is noted of establishing national monitoring programmes for usage of 
antimicrobial agents in animal production, including poultry production. Currently, there 
is good progress in this fi eld in some countries. However, monitoring programmes need 
to  be  harmonized  for  comparability  between  countries.  The  introduction  of  an  EU 
database on drug usage in food animals would contribute to such monitoring. Further 
discussion,  including  a  workshop  on  best  and  feasible  practices  for  monitoring  drug 
usage, should be held, to recommend a common system for EU countries. 

The  exact  relationship  between  antimicrobial  use,  including  FQ,  and  resistance  require 
further  investigation.  Experiences  from  diff erent  countries,  e.g.  the  US  and  Australia, 
regarding policies and interventions on FQ use, need to be studied. For example, what is 
the public health impact and what are the eff ects on the poultry industry, including animal 
health?  A  careful  re-analysis  of  previous  work  regarding  the  public  health  risks  of  FQ-
resistant  versus  FQ-susceptible  Campylobacter  strains  should  be  considered.  There  is  a 
need for more studies to assess the risk factors for FQ resistant Campylobacter infection. 
Also,  the  impact  of  the  importation  of  FQ-resistant  Campylobacter  through  food  from 
third  countries  should  be  assessed.  One  approach  could  be  to  conduct  longitudinal 
studies in human volunteers (travel, type of foods (broiler meat, imported foods), patients’ 
previous antimicrobial exposure, etc.), including susceptibility profi les and typing of the 
isolates,  with  regular  samples  from  environmental  sources  and  samples  from  locally-
produced and imported foods from the same period. Such risk factor studies should not 
focus  on  broiler  meat  only,  but  include  all  poultry  meats  (e.g.  there  is  usually  higher 
antibiotic use in turkey production). There is also a lack of knowledge regarding whether 
FQ-resistant  isolates  belong  to  specifi c  clones  and/or  have  particular  properties  (e.g. 
increased fi tness or virulence).

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

25.

The discussion group agreed the following main conclusions to be reported back to the 
fi nal plenary session:

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

There is scientifi c evidence that the use of FQ in poultry has led to the emergence of 
FQ-resistance in Campylobacter in poultry and that such strains have further spread to 
humans.

There is a public health benefi t from reducing FQ use in food animals, including poultry. 
However, is it not yet possible to quantify the eff ect in the case of Campylobacter.

Diff erent studies/reviews/analyses have reached diff erent conclusions as to whether 
FQ-resistant strains are more hazardous to public health than FQ-susceptible strains.

Severe  cases  of  diarrhoea  of  unknown  origin  are  normally  treated  empirically  with 
antimicrobials and if FQ resistant Campylobacter are present there may be an increased 
risk of treatment failure and adverse outcome. 

There  are  recent  indications  of  increased  infection  rates  with  FQ-resistant 
Campylobacter strains in humans that are receiving FQ treatment. 

It is possible to produce poultry with limited, or even without, FQ use. However, there 
is a need for more data on the public health benefi t and the impact on the poultry 
industry including animal health.

FQ is a critically important drug in humans and should therefore be a drug of last resort 
for therapeutic use in food animals.

Prudent antimicrobial use policy in all sectors should be promoted and adhered to.

26.

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Reports from Discussion Groups

DG4:  ASSESSMENT OF EFFECTIVENESS OF CONTROL MEASURES 

IN THE FOOD CHAIN

Assessment of eff ectiveness of control measures in the food chain has to be made on the 
basis  of  evidence-based  science  rather  than  the  socio-economic  constraints  related  to 
the  food  industry  or  consumer/political  premise.  Before  addressing  the  four  questions 
raised to the group, a number of presumptions were discussed, including: (i) pre-harvest 
is defi ned as before animals are killed and all steps in the production chain after killing are 
defi ned as post-harvest, (ii) it must be assumed that GHP and HACCP are fully implemented 
management systems (iii) pre- and post-harvest measures may be complementary in their 
eff ect but need to be considered separately and (iv) conventional systems are the norm 
for  broiler  production,  and  although  organic/free  range  systems  must  be  considered, 
chickens produced by such management systems are in the minority.

1.  From the European perspective, consider the eff  ectiveness of current and 
proposed pre- and at-harvest controls for Campylobacter in broiler chicken 
fl ocks and propose further studies to develop more eff  ective controls. State 
the strong and weak points of the control measures identifi ed, considering 
explicitly the perspective of industry and consumers, and identify possible 
barriers to their introduction.

Pre-harvest control options

Some aspects of increasing biosecurity can be carried out at relatively low cost and could 
be implemented without the need for further research. However, to maintain biosecurity, 
every single opening in a poultry house needs to be closed or protected, which is largely 
impractical. 

Recently, a critical review of risk factors for Campylobacter on farm has been completed 
(FSA, 2009). This highlighted that some risk factors are common between countries but 
others  are  more  country  or  region  specifi c  (e.g.  drinking  water  in  Nordic  countries). 
Additionally,  the  risk  factors  may  vary  over  the  year.  In  particular  the  major  risk  factors 
during the peak months appear to be diff erent than in the rest of the year and the timing, 
extent  and  importance  of  seasonality  can  vary  between  countries.  Consequently,  the 
assessment  of  the  effi  cacy  of  diff erent  biosecurity  measures  is  complex  and  cost/
eff ectiveness should be estimated separately for each country.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

27.

Intervention studies on biosecurity measures have been performed with diff erent levels 
of success in diff erent countries. Such variation may be explained by diff erences in the 
Campylobacter ‘loads’ in the environment. Thus the eff ectiveness of biosecurity-related 
intervention strategies in primary production, might be strongly dependent on regional 
conditions. 

Data  collected  over  the  years  in  Europe  suggests  much  lower  prevalence  in  fl ocks  in 
Nordic countries compared to countries in more median latitudes like United Kingdom or 
the Netherlands and a very high prevalence in southern countries such as Spain and Italy. 
This may be a result of climatic factors (e.g. temperature, humidity) but may also refl ect 
management  diff erences  in  poultry  production,  like  the  popular  free-range  systems  in 
France.  The  current  EU  baseline  study  using  standardised  methods  will  show  whether 
these presumed diff erences in prevalence are true. 

In conclusion, although a general level of biosecurity should be established, regional and/
or  seasonal  modifi cations  must  be  added  and  even  so  eff ectiveness  cannot  be 
guaranteed.

Thinning, which is partial depopulation, is identifi ed as a signifi cant risk factor in many 
studies. The explanation is that the maintenance of reasonable levels of biosecurity by 
thinning crews and their equipment is impractical. The risk of detectable colonization of a 
substantial part of the remaining fl ock is related to the number of days the birds stay on 
the  farm.  This  refl ects  the  5-7  days  before  the  fl ock  is  detectably  colonized  with 
Campylobacter  after  initial  introduction.  One  country  with  an  eff ective  Campylobacter 
control plan (Iceland) does not apply thinning, as part of its biosecurity measures. 

Age of birds is also a major risk factor and has been well described in many prevalence 
studies world-wide. Iceland, and some other Nordic countries, slaughter birds at younger 
ages (about 33 days, particularly in summer). In other countries, birds are larger and older 
(i.e.  in  Denmark,  birds  are  on  average  45  days  of  age  at  slaughter).  The  prevalence  of 
Campylobacter-positive fl ocks increases with the age of the birds.

Drinking  water  may  be  a  risk  factor  but  there  are  reported  regional  diff erences  on 
the relative importance of this risk factor and this may relate to the water source (i.e. mains 
or  bore  hole).  Simple  measures  are  available  for  the  treatment  of  drinking  water 
(UV-treatment).

28.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Reports from Discussion Groups

There  are  several  options  for  feed  and  or  water  additives  (e.g.  organic  acids).  The 
eff ectiveness  is  variable  for  diff erent  products  and  the  claims  are  sometimes  hard  to 
reproduce in slightly diff erent settings. 

Additional measures that are under development to be considered in the longer term are 
vaccination, phage therapy and bacteriocins. Such approaches are needed to complement 
biosecurity and for implementation in non/less-biosecure production systems (e.g. free 
range systems). However, considerable additional research on these strategies is needed. 
Some (i.e. bacteriophages and bacteriocins) are ready to test under fi eld conditions but 
appropriate fi eld conditions (e.g. contained poultry houses) are lacking and the current EU 
legislation precludes the controlled studies that are needed. 

Transportation from the farm to the processing plant is not seen as a major risk factor for 
contamination of the fi nal product, but might be an issue to the farmer if a negative fl ock 
becomes contaminated during transport and this aff ects payment of incentive bonuses.

Logistic slaughter, which is the separate processing of negative and positive fl ocks, will 
not necessarily have an impact on the reduction of human campylobacteriosis, in terms of 
preventing cross-contamination in the processing line, as the numbers of Campylobacter 
tend  to  be  low  on  any  cross-contaminated  carcasses  from  negative  fl ocks.  However, 
scheduled slaughter could be eff ective when combined with the diversion of the products 
from positive fl ocks towards freezing or other treatment such as cooking. Nevertheless, 
scheduled slaughter is logistically impractical when the prevalence of positive  fl ocks is 
high. Consequently, the implementation of such a strategy would be country- and season- 
dependent. A rapid test to show the Campylobacter status of the fl ocks, preferably on farm 
at  the  day  before  slaughter,  would  facilitate  eff ective  implementation  of  such  an 
intervention.  

An  overview  of  the  possible  control  options,  indicating  eff ectiveness,  strong  and  weak 
points, barriers to introduction and an indication of the further research needed, is listed 
in Table 1 (pre-harvest). 

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

29.

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Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

31.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Post-harvest

Table  2  contains  a  list  of  possible  post-harvest  strategies  with  detailed  comments. 
Carcasses  with  the  highest  Campylobacter  contamination  levels  are  considered  to 
contribute  most  to  the  number  of  human  campylobacteriosis  cases  (though  this 
assumption  has  been  questioned  by  DG2).  However,  the  within-batch  contamination 
levels are not homogeneous. More research is needed to generate reliable methods and 
strategies  to  detect  the  most  highly  contaminated  carcasses  in  order  to  identify  such 
products.

The detection of faecally-contaminated carcasses is theoretically one way to enable the 
removal or decontamination of highly contaminated carcasses. USDA, ARS has developed 
and  validated  an  on-line  sensing  technology  system  for  wholesomeness  inspection  of 
freshly slaughtered chickens. The FSIS Risk Management Division approved the technology 
for commercial implementation to pre-sort chicken carcasses online. However, it is not yet 
clear how this system will perform in a fully operational processing plant. 

Although Campylobacter blood infection may occur in chickens, and poultry meat/off al 
may be internally contaminated, the highest level of the contamination is expected to be 
at carcass surface.  

Physical decontamination, such as freezing and crust freezing will reduce the Campylobacter 
levels by a few logs but crust freezing has to be combined with additional methods (e.g. 
ultrasound) to have any real impact. The feasibility of introduction of such processes in 
fully operational production lines is questionable.

Based on an extensive surveillance programme at production, one country (Iceland) has 
legal  requirements  on  freezing  (or  heat  treating)  the  whole  fl ock  of  broilers,  which  are 
Campylobacter-positive  prior  to  slaughter.  As  it  is  important  for  the  poultry  industry  to 
market fresh poultry meat, the farmers have placed their eff ort in producing Campylobacter-
negative fl ocks. Concurrent with this strategy, the incidence of human campylobacteriosis 
of domestic origin has been reduced from 117 cases in 1999 to about 10 – 15 cases per 
100.000 inhabitants in the last three years. 

Processing technologies that could reduce Campylobacter viable numbers on carcasses, 
such as air chilling, should be considered.

32.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Reports from Discussion Groups

At the end of the slaughter line the poultry end-product should be placed in leak proof 
packaging.  Fluid  absorbing  packaging  or  edible  fi lms  may  help  in  preventing  cross-
contamination in the kitchen. Modifi ed atmosphere packaging (MAP) is under development 
and may reduce the numbers of viable Campylobacter. However, it should be recognised 
that  modern  processing,  which  generates  very  short  production  chains,  and  retailing 
using protective plastics and dark, moist and cool storage, all contribute to Campylobacter 
survival on the end product.

With reference to product labelling there are confl icting opinions. The labelling of meat as 
Campylobacter-negative may result in less careful handling by consumers and this would  
be undesirable.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

33.

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Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

35.

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2.  List and rank the possible post-harvest controls in terms of eff  ectiveness 

from a European perspective. 

A list of potential measures for consideration are given in Table 2. As the eff ectiveness of 
most of the potential control measures is hard to quantify, it was considered infeasible at 
this stage to rank these measures.

3.  Consider the evidence on the eff  ectiveness of producer, processor and 
consumer education to reduce the risk of human campylobacteriosis. 
Consider the need for new studies aimed at the identifi cation, collection 
and evaluation of new data on the eff  ectiveness of education and 
awareness programmes.

The eff ect of education was briefl y discussed for 3 groups in the food chain:

Producers

For producers educational messages tend to be short lived, incentive- and cost-related. 
However, some countries have invested in educational programmes particularly related 
to  biosecurity  on  farms,  and  targeted  towards  the  farm  staff   and  catching  crews.  Such 
programmes have included the distribution of printed booklets, posters and talks. There 
is  no  evidence  of  the  eff ectiveness  of  such  measures  largely  because  they  are  rarely 
implemented in isolation from other strategies and because monitoring of the eff ect on 
fl ock-positivity over time is not undertaken. 

Processor

The message for producers is also short lived. HACCP compliance is already high and it is 
diffi  cult  to  see  how  this  helps  with  an  organism  that  does  not  grow  under  natural 
conditions  outside  the  host.  This  may  change  if  eff ective  post-harvest  interventions 
become available.

36.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Reports from Discussion Groups

Consumer

The message for the consumer is also short lived; the evidence suggests that people do 
not listen to educational messages. The best approach may be through school children, 
who can educate their parents.

4.  Consider at which points along the food chain, monitoring, targets, 

microbiological criteria, and/or performance objectives would be most 
eff  ective and recommend how best this would be implemented.

There are multiple points along the food chain at which monitoring can take place. Each 
has its own advantages and disadvantages.

On-farm monitoring gives the option for the separation of positive from negative fl ocks 
and  could  monitor  the  eff ectiveness  of  biosecurity  but  is  remote  from  the  consumer. 
There  is  also  the  issue  of  late  fl ock-positivity,  which  might  reduce  the  sensitivity  of 
monitoring  particularly  after  thinning.  The  monitoring  of  faecal  material  only  also  has 
problems of sensitivity. 

Monitoring of birds at slaughter using culture of caecal contents is closer to the consumer 
and likely to give a more reliable positive or negative result. Caecal contents tend to have 
very high bacterial numbers, which ensures eff ective bacterial recovery. This strategy has 
been used for the EU baseline survey and is considered eff ective. 

Monitoring at the end of the slaughterline can take into account the eff ectiveness of any 
post-harvest 
interventions  during  processing.  Moreover,  this  stage  can  provide 
quantitative  indicators  of  bacterial  load  on  the  carcass,  which  would  give  the  most 
valuable  information  to  incorporate  into  risk  assessment  models  and  assess  the 
eff ectiveness of interventions.

Retail monitoring is the closest to the consumer but does not provide information on the 
eff ectiveness of, or give options for, interventions. Importantly, the distinction between 
imported and domestically produced products would be unclear, so domestic interven-
tions would not necessarily be assessible. In addition, the time that the product was on 
the retail shelf would be variable and this could have a big eff ect on bacterial numbers.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

37.

It  seems  likely  that  a  combination  of  monitoring  points  will  be  needed  to  provide  the 
most appropriate information. 

The discussion group discussed some concluding remarks at the end of the session:

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

In the current economic climate there is an increasing demand for cheaper products 
and consequently imports may increase with unknown eff ects on risk.

Alternative systems with reduced biosecurity are a challenge for the balance between 
welfare and product safety.

Campylobacter strain diff erences, for example with regard to survival 
There are clear 
along the food chain and (probably) virulence traits.  This fi eld needs more research to 
come to a diff erentiated risk assessment.

Incentives for farmers would increase the farmers’ motivation to produce 
free fl ocks. 

Campylobacter 

There should be a fully integrated farm-to-consumer approach.

Focus should be on decontamination/elimination of highly contaminated carcasses.

38.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

III   FINAL PLENARY DISCUSSION: 

CONCLUSIONS & RECOMMENDATIONS

Conclusions and recommendations

HEALTH IMPACT AND ATTRIBUTION OF CAMPYLOBACTER

Even though Campylobacter is recognized as the leading cause of acute bacterial enteritis 
in Europe, the true incidence of campylobacteriosis is considerably higher than reported, 
and  the  under-ascertainment  is  likely  to  vary  considerably  between  countries.  Public 
health  surveillance  systems  need  to  be  further  strengthened,  and  focussed  studies  to 
calibrate the “surveillance pyramid” should be encouraged. To better understand the full 
disease  burden,  case-based  reporting  in  the  Member  States  needs  further  promotion. 
Collaboration  between  the  medical  profession  and  experts  in  the  food  and  veterinary 
sectors, and other specialists, is key to improving the data collection needed to provide 
baseline  information  on  campylobacteriosis  and  to  monitor  the  eff ectiveness  of 
interventions. New tools for source attribution of campylobacteriosis are emerging, and 
standardised data collection across the EU to inform such studies should be encouraged.

Specifi c research needs and recommendations identifi ed in this area include:

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

The  importance  of  poultry  meat  as  a  vehicle,  and  poultry  as  a  reservoir  for  human 
campylobacteriosis,  should  be  established  in  order  to  better  determine  where 
interventions would be most eff ective. 

Passive  surveillance  is  not  capable  of  demonstrating  the  impact  of  interventions  in 
the  food  chain  on  public  health.  Active  surveillance  is  needed  to  demonstrate  that 
a specifi c intervention has delivered a public health eff ect.

New and innovative chicken products coming onto the market have to be considered 
in any risk assessment or source attribution exercise, as experience in some countries 
has already shown them to have a signifi cant eff ect on human exposure.

Campylobacter,  using 
An  international  strain-typing  database,  including  data  on 
unbiased and appropriately structured sampling methods, from all sources (animals, 
food, humans and environmental) is a priority. Strains in such databases need to be 
made readily available for research.

It has been diffi  cult to harmonise typing methodology against a background of rapidly 
improving methodology. Ideally, a decision would be made to focus on one or a few 
methods.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

39.

QUANTITATIVE RISK ASSESSMENT OF CAMPYLOBACTER IN BROILER MEAT 
IN THE EU

Even  though  there  are  many  reservoirs  and  transmission  routes  for  the  bacterium, 
contaminated  poultry  meat  is  considered  to  be  a  major  source  of  human  exposure. 
Quantitative  risk  assessment  models  have  provided  new  insights  to  support  risk 
management  strategies  particularly  applied  to  the  poultry  food  chain.  Further 
development of these models, including application at the EU-level rather than country 
level, should be encouraged to support decision-making. Access to reliable quantitative 
data  at  each  stage  of  the  production  chain  throughout  Europe  will  help  to  fi ne-tune 
models for risk assessment and will contribute to our understanding of those interventions 
that are likely to be most successful. There are many data gaps, in particular with reference 
to  fi eld  data.  However,  it  will  be  a  time-consuming  process  to  address  this  and  risk 
management action may be considered while these data gaps are being fi lled. 

Specifi c research needs and recommendations identifi ed in this area include:

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

The currently available risk assessment models are good enough for scenario analysis, 
but are incapable of predicting real numbers of human cases.

The currently available QMRA models are often based on assumptions, or are tailored 
to farming, processing or consumption patterns,  that may be Member State specifi c 
and will thus need adapting before application in risk assessments at an EU level. 

A pragmatic approach to QMRA is important in order to give a timely output. Current 
limitations  on  data  availability  should  not  delay  eff orts  to  model  the  European 
situation. 

Field  studies  (pilot  then  full  scale),  to  validate  promising  intervention  strategies 
identifi ed  by  QMRA  studies,  are  needed.  Currently,  fi eld  trials  are  using  ad  hoc 
experimental  set-ups.  The  elaboration  of  harmonized  protocols,  with  minimum 
requirements for conducting fi eld trials, is recommended. 

40.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Conclusions and recommendations

FLUOROQUINOLONE RESISTANCE IN CAMPYLOBACTER

There is evidence that the use of fl uoroquinolones in poultry has led to the emergence of 
fl uoroquinolone  (FQ)  resistance  in  Campylobacter  in  poultry  and  contributes  to  the 
occurrence of antibiotic-resistant Campylobacter infection in humans. It is to be expected 
that  there  would  be  public  health  benefi t  in  reducing  fl uoroquinolone  use  in  animals, 
although it is not yet possible to quantify this in the case of Campylobacter. There is a need 
to monitor usage of antimicrobial substances overall in animals. In particular, monitoring, 
preceded  by  appropriate  modelling,  should  be  considered  as  a  preliminary  step  when 
planning any intervention.

Few  data  exist  on  the  establishment  of  reservoirs  of  FQ  resistant  Campylobacter in  the 
environment  [exceptions  include  (Leatherbarrow  et  al.,  2004;  Waldenstrom  et  al.,  2005; 
Fallacara et al., 2001)].  Such data would help to establish the potential for control measures 
to reverse the upward trend of prevalence of FQ resistant Campylobacter. Nevertheless, 
control measures may at least ensure that further emergence could be prevented. Existing 
research  suggests  that  the  prevalence  of  FQ  resistant  Campylobacter  remains  constant 
following withdrawal of FQ, implying that it is “fi t” and established in the environment 
(Luangtongkum et al., 2009).

Specifi c research needs and recommendations identifi ed in this area include:

 (cid:2)

 (cid:2)

In future, in order to better assess the eff ectiveness of control measures, it is strongly 
recommended that monitoring studies are undertaken parallel to interventions.

As a fi rst step towards managing the increasing prevalence of antimicrobial resistance, 
better  reporting  of  all  antimicrobial  use,  by  sector,  is  essential,  and  should  be 
coordinated and harmonised at a European level. 

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

41.

ASSESSMENT OF EFFECTIVENESS OF CONTROL MEASURES IN THE FOOD CHAIN

Several possibilities for intervention at various stages in the broiler meat food chain have 
already  been  identifi ed.  Prevention  of  fl ock  colonisation  would  be  ideal  but  reducing 
numbers of Campylobacter on a carcass, rather than complete elimination, may also have 
important public health benefi ts. Experts noted that it is unlikely that there will be a single 
eff ective measure applicable across all Member States. Currently available interventions 
are  apparently  limited  in  their  eff ectiveness  or  diffi  cult  to  sustain.  Well-designed  fi eld 
trials, informed by quantitative risk assessments, to test the most promising strategies, are 
needed. Novel control strategies are also required but will need advanced planning for 
the evaluation of effi  cacy and safety.

Specifi c research needs and recommendations identifi ed in this area include:

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

Campylobacter on carcasses as well 
Control should aim at reducing the numbers of 
as prevalence of contaminated carcasses, although these are two sides of the same 
coin.  This  in  turn  could  lead  to  a  defi nition  of  appropriate  sensitivity  of  detection 
methodologies, which would be useful.

Education is very important, and should start with children – there is currently in the 
EU  much  work  on  nutritional  education which  could  be  extended  to  include  food 
hygiene.  There  are  ongoing  opportunities  to  reinforce  food  safety  education  (e.g. 
E-Bug project).

The labelling of poultry meat products as part of an education campaign might be 
worth considering. However, labelling on how to safely handle and cook the product, 
has very diff erent implications from labelling the product as “free from Campylobacter”. 
Multi-disciplinary  studies  on  Campylobacter  interventions  should  in  future  include 
social scientists to understand the impact of human behaviour.

There is a need for a harmonized protocol for assessing control measures with fi xed 
numbers of farms/fl ocks, to allow for rapid validation of intervention strategies. Crite-
ria need to be defi ned for assessing safety and effi  cacy of novel intervention methods 
like phage therapy.

42.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Conclusions and recommendations

 (cid:2)

 (cid:2)

Many  barriers  to  introducing  control  measures  are  economic.  The  European 
Commission may need to consider what incentives are necessary, as industry margins 
are very low.

Interaction  between  the  leading  European  agencies,  EMEA,  ECDC,  EFSA  and  the 
European Commission will be important to successfully address the problem.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

43.

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References

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EFSA  (European  Food  Safety  Authority),  2008c.  Report  of  Task  Force  on  Zoonoses  Data 
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Endtz H.P., Ruijs G.J., van Klingeren B., Jansen W.H., van der Reyden T. and Mouton R.P., 
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Evers  E.  G.,  van  Der  Fels-Klerx  H.  J.,  Nauta  M.J.,  Schijven  J.F.  and  Havelaar  A.H.,  2008. 
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Fallacara  D.  M.,  Monahan  C.  M.,  Morishita  T.Y.  and  Wack  R.F.,  2001.  Fecal  shedding  and 
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FDI/236/2005. Enhancing Surveillance of Potentially Foodborne Enteric Diseases in New 
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FSA (Food Standards Agency), 2009. A critical review of interventions and strategies (both 
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Havelaar A. H., van Pelt W., Ang C.W.,. Wagenaar J.A., Gross U., van Putten J.P.M. and Newell 
D.G.,  2009.  Immunity  to  Campylobacter:  its  role  in  risk  assessment  and  epidemiology. 
Critical Reviews in Microbiology, in press.

Havelaar  A.  H.,  Vargas  Galindo  A.,  Kurowicka  D.  and  Cooke  R.  M.,  2008.  Attribution  of 
Foodborne  Pathogens  Using  Structured  Expert  Elicitation.  Foodborne  Pathogens  and 
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Helms  M.,  Simonsen  J.,  Olsen  K.  E.  and  Molbak  K.,  2005.  Apr  1.  Adverse  health  events 
associated with antimicrobial drug resistance in Campylobacter species: a registry-based 
cohort study. J Infect Dis. 191(7): pp. 1050-5.

Leatherbarrow A. J., Hart C. A., Kemp R., Williams N. J., Ridley A., Sharma M., Diggle P. J., 
Wright  E.  J.,  Sutherst  J.  and  French  N.  P.,  2004.  Genotypic  and  antibiotic  susceptibility 
characteristics  of  a  Campylobacter  coli  population  isolated  from  dairy  farmland  in  the 
United Kingdom. Appl Environ Microbiol 70(2): pp. 822-30.

Luangtongkum T., Jeon B., Han J., Plummer P., Logue C.M. and Zhang Q., 2009. Antibiotic 
resistance in Campylobacter: emergence, transmission and persistence. Future Microbiol, 
Mar 4: pp. 189-200.

Nachamkin  I.,  Ung  H.  and  Li  M.,  2002.  Increasing  fl uoroquinolone  resistance  in 
Campylobacter jejuni, Pennsylvania, USA, 1982–2001, Emerg Infect Dis 8, pp. 1501–1503.

Nelson J. M., Chiller, T. M., Powers, J. H. and Angulo, F. J., 2007. Fluoroquinolone-resistant 
Campylobacter  species  and  the  withdrawal  of  fl uoroquinolones  from  use  in  poultry:  a 
public health success story. Clin Infect Dis. 44(7): pp. 977-80.

Norström M., Hofshagen M., Stavnes T., Schau J., Lassen J. and Kruse H., 2006. Antimicrobial 
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Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

References

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jejuni  infections  in  industrialized  countries.  In  Campylobacter  3rd  ed.,  Nachamkin  I, 
Szymanski CM, Blaser MJ. ASM Press, Washington DC., pp. 163-189.

Staff ord R. J., Schluter P., Kirk M., Wilson A., Unicomb L., Ashbolt R. and Gregory J., 2007. A 
multi-centre prospective case-control study of Campylobacter infection in persons aged 5 
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Thwaites R.T. and Frost J.A., 1999. Drug resistance in Campylobacter jejuni, C. coli, and C. lari 
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Waldenstrom J., Mevius D., Veldman K., Broman T., Hasselquist D. and Olsen B., 2005. Anti-
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Appl Environ Microbiol 71(5): pp. 2438-41.

Wassenaar T.M., Kist M., de Jong A., 2007. Re-analysis of the risks attributed to ciprofl oxacin-
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Wheeler J.G., Sethi D., Cowdon J.M., Wall P.G., Rodrigues L.C.  Tomkins D.S.,  1999. Study of 
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Whittemore,  A.  S.,  1983.  Estimating  attributable  risk  from  case-control  studies.  Am  J 
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47.

48.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

ANNEXES

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

49.

50.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

V ANNEXES

Annex 1:   Programme of the Colloquium

Annex 2:  Participants at the Colloquium

Annex 3:   Presentations of speakers

Annex 4:   Presentations of Discussion Groups 

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

51.

52.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 1 

  Programme of the EFSA Colloquium

ANNEX 1: PROGRAMME OF THE EFSA COLLOQUIUM

Assessing health benefi ts of controlling Campylobacter in the food chain

4-5 December 2008, Rome, Italy

PROGRAMME

Overall chairs: 

Arie Havelaar 
RIVM, Netherlands

Marta Hugas
BIOHAZ Unit – EFSA

Overall 
rapporteurs: 

Diane Newell
United Kingdom

Tobin Robinson
BIOHAZ Unit – EFSA

Day 1

09.00-13.00

Session 1:
INTRODUCTORY PLENARY SESSION

09.00-09.15 Welcome and introduction to EFSA

09.15-09.30

Objectives of the Colloquium

09.30-09.50

New approaches to source attribution 
and their role in reducing 
campylobacteriosis notifi cations 
in New Zealand

09.50- 10.00 Questions

Hubert Deluyker
Director Scientifi c Cooperation 
& Assistance, EFSA
Presented by Marta Hugas
Arie Havelaar
RIVM, Netherlands

Nigel French
Massey University, New Zealand

10.00-10.20

Campylobacter Risk Assessment 
in the EU: Past, present and future

Maarten Nauta
RIVM, Netherlands 

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

53.

 
10.20- 10.30 Questions

11.00-11.20

11.20-11.30

Presentation 
as introduction to DG 3
Questions

Frank Aarestrup
CRL - Antimicrobial Resistance

11.30-11.50

11.50-12.00

Measures to control Campylobacter 
in broilers and broiler meat
Questions

Hanne Rosenquist
Technical University of Denmark

12.00-12.20

General discussion 

Chairs

12.20-12.30

Introduction to discussion groups

Stef Bronzwaer
Scientifi c Cooperation Unit, EFSA

54.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 1 

  Programme of the EFSA Colloquium

14.00-18.00

Session 2:
DISCUSSION GROUPS (DG)
Four parallel discussion groups to address:

DG 1 Health impact and attribution of Campylobacter

Chair: Kare Molbak

Statens Serum Institute, Denmark

Rapporteur: Paolo Calistri Istituto Zooprofi lattico 

Sperimentale dell’Abruzzo e del Molise, Italy

DG 2 Quantitative risk assessment 

of Campylobacter in broiler meat in the EU

Chair: Gilles Salvat

AFSSA, France

Rapporteur: Mieke Uyttendaele

University of Gent, Belgium

DG 3 Fluoroquinolone resistance in Campylobacter
Chair: Guenter Klein

University of Veterinary Medicine Hannover, 
Germany

Rapporteur: Hilde Kruse

WHO Regional Offi  ce for Europe

DG 4 Assessment of eff ectiveness 

of control measures in the food chain
Chair: Dan Collins

University College Dublin, Ireland

Rapporteur: Jaap Wagenaar

University of Utrecht, Netherlands

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

55.

 
Day 2

09.00-10.00

Session 3:
CONTINUATION OF DISCUSSION GROUPS
Including discussion on the outcomes of the discussion groups 
and the production of reports to the plenary session

10.30-13.30

Session 4:
FINAL PLENARY SESSION

10:30-10:50

Report back from discussion group 1

10:50-11:05

Discussion

Paolo Calistri
Istituto Zooprofi lattico 
Sperimentale dell’Abruzzo e 
del Molise, Italy 

11:05-11:25

Report back from discussion group 2

Mieke Uyttendaele
University of Gent, Belgium

11:25-11:40

Discussion

11:40-12:00

Report back from discussion group 3

12:00-12:15

Discussion

12:15-12:35

Report back from discussion group 4

12:35-12:50

Discussion

12:50-13:30

General discussion
Conclusions and take-home message

Hilde Kruse
WHO Regional Offi  ce 
for Europe 

Jaap Wagenaar
University of Utrecht, 
Netherlands

Chairs
Diane Newell, overall 
rapporteur

14.30

COLLOQUIUM ADJOURNS

56.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 2 

  Participants at the Colloquium

ANNEX 2: PARTICIPANTS AT THE COLLOQUIUM

Country

Discussion 
Group (DG)

Name

Affi  liation

Dr Frank Aarestrup 

National Food Institute (DTU)

Dr Thomas Alter 

Dr Antonio Battisti 

Mr Aivars Berzins 

Federal Institute for Risk Assessment 
(BfR)

Collaborating Center for Veterinary 
Training, Epidemiology, Food Safety 
and Animal Welfare of Tuscany and 
Lazio

Institute of Food and Environmental 
Hygiene (FVM)

Dr Louise Boysen

National Food Institute (DTU)

Prof. Dr Lone Brøndsted

University of Copenhagen

Dr Andrea Brtkova

State Veterinary and Food Institute

Dr Luca Bucchini

Hylobates Consulting s.r.l.

Dr Sabina Buettner

Federal veterinary offi  ce (FVO)

Dr Paolo Calistri

Mr Luca Cocolin

Collaborating Center for Veterinary 
Training, Epidemiology, Food Safety 
and Animal Welfare of Abruzzo and 
Molise

International Journal of Food 
Microbiology

Prof. Pierre Colin

University of Western Britain

Prof. John Daniel Collins

University College Dublin (UCD)

Dr Roberto Condoleo

Collaborating Center for Veterinary 
Training, Epidemiology, Food Safety 
and Animal Welfare of Tuscany 
and Lazio

DK

DE

IT

LV

DK

DK

SE

IT

CH

IT

IT

FR

IE

IT

Mrs Sigurborg Dadadottir The Icelandic Food and Veterinary 

IS

Authority

3

4

1

1

1

1

3

2

3

1

2

3

4

2

4

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

57.

 
Name

Affi  liation

Country

Discussion 
Group (DG)

Dr  Paolo Daminelli

Dr Kris De Smet

Collaborating Center for Veterinary 
Training, Epidemiology, Food Safety 
and Animal Welfare of Lombardia 
and Emilia Romagna

European Commission, Directorate 
General for Health and Consumer 
Aff airs

Dr Elisabetta Di Giannatale Collaborating Center for Veterinary 
Training, Epidemiology, Food Safety 
and Animal Welfare of Abruzzo 
and Molise

Prof. Dr Zerrin Erginkaya

Çukurova University

Dr Maurizio Ferri

Dr Alessia Franco

Local Health Unit Pescara, Veterinary 
Service

Collaborating Center for Veterinary 
Training, Epidemiology, Food Safety 
and Animal Welfare of Tuscany 
and Lazio

Prof. Nigel French

Massey University

Dr Norbert Ginten

Emsland-Frischgefl ügel

Mr  Ihab Habib

University of Gent

Mrs Marjaana Hakkinen

Finnish Food Safety Authority (EVIRA)

Prof. Marja-Liisa Hanninen University of Helsinki

Prof. Arie Havelaar

National Institute for Public Health 
and the Environment (RIVM)

Dr  Merete Hofshagen

National Veterinary Institute (NVI)

Dr  Mary Howell

The Food Standards Agency (FSA)

Mrs Andrea Humski

Croatian Veterinary Institute (CVI)

Prof. William Keevil

University of Southampton

Prof. Dr  Günter Klein

University of Veterinary Medicine 
Hannover

IT

BE

IT

TR

IT

IT

NZ

DE

BE

FI

FI

NL

NO

UK

HR

UK

DE

58.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

1

4

3

4

2

3

1

4

2

1

3

1

4

1

2

2

3

Annex 2 

  Participants at the Colloquium

Name

Affi  liation

Country

Discussion 
Group (DG)

Dr Günther Kraus

Dr Hilde Kruse

Austrian Agency for Health and Food 
Safety (AGES)

World Health Organization, 
Regional Offi  ce for Europe

Dr Roland Lindqvist

Swedish National Food Administration

Dr Ida Luzzi

Istituto Superiore di Sanità (ISS)

Dr Gerardo Manfreda

University of Bologna

Dr Antonio Martinez Lopez Institute of Agrochemistry and Food 

Dr Winy Messens

Technology (CSIC)

Institute for Agricultural and 
Fisheries Science

Dr Kåre Mølbak

Statens Serum Institut

Dr Dominique L. Monnet

European Centre for Disease 
Prevention and Control (ECDC)

Dr Maarten Nauta

National Food Institute (DTU)

Prof. Diane Newell

Foodborne Zoonoses Consultancy

Dr Lisa O’Connor

Food Safety Authority of Ireland

Dr Eva Olsson Engvall

Dr Antonio Parisi

Mr Pavel Pollak

Dr Miguel Prieto

Dr Franco Rigo

Dr Mati Roasto

National Veterinary Institute, 
CRL- Campylobacter

Collaborating Center for Veterinary 
Training, Epidemiology, Food Safety 
and Animal Welfare of Puglia and 
Basilicata

Institute of Public Health of Slovenia

University of León

UNA SITO

Estonian University of Life Sciences

Dr Hanne Rosenquist

Technical University of Denmark

Mr Gilles Salvat

Dr Moez Sanaa

French Food Safety Agency (AFSSA)

Veterinary School of Alfort

AT

IT

SE

IT

IT

ES

BE

DK

SE

DK

UK

IE

SE

IT

SI

ES

IT

EE

DK

FR

FR

1

3

2

3

1

4

2

1

3

2

4

4

4

3

2

3

4

3

4

2

2

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

59.

 
Name

Affi  liation

Country

Discussion 
Group (DG)

2

4

3

3

1

1

3

2

4

3

4

2

4

2

1

4

1

4

Dr Snieguole 
Sceponaviciene

National Food and Veterinary Risk 
Assessment Institute

Dr Pavle Sekulovski

National Food Institute

Prof. Peter Silley

MB Consult Limited

Prof. Dr Iva Steinhauserova University of Brno

Dr Anca-Violeta Stoicescu Institute for Hygiene and Veterinary 

Dr Johanna Takkinen

Dr Benno Ter Kuile

Public Health

European Centre for Disease 
Prevention and Control (ECDC)

Netherlands Food and Consumer 
Product Safety Authority (VWA)

Dr Nicola Tornaletti

UNICEB/Fiorucci

Dr Mary Torrence

U. S. Department of Agriculture

Mr Jordi Torren Edo

European Medicines Agency (EMEA)

Mrs Mª Esther Tortuero

City Council of Madrid

Prof. Dr Mieke Uyttendaele University of Gent

Dr Emanuela Varani

Negroni SpA

Dr Peter Van Der Logt

New Zealand Food Safety Authority

Dr Wilfrid Van Pelt

National Institute for Public Health 
and the Environment (RIVM)

Dr Ana Vidal

Veterinary Laboratories Agency (VLA)

Prof. Ana Cristina Vilela

University of Lisbon

Prof. Jaap Wagenaar

University of Utrecht

Dr Paul Whyte

University College Dublin (UCD)

Dr Kinga Wieczorek

Dr Siamak Yazdankhah

Mrs Carmen Zigorraga

National Veterinary Research 
Institute

Norwegian Scientifi c Committee for 
Food Safety

Health Department Basque 
Government

60.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

LT

MK

UK

CZ

RO

SE

NL

IT

US

UK

ES

BE

IT

NZ

NL

UK

PT

NL

IE

PL

NO

ES

3

1

2

3

Annex 2 

  Participants at the Colloquium

EFSA Staff 

Dr Stef  Bronzwaer

Scientifi c Cooperation and Assistance, Scientifi c 
Cooperation Unit

Dr Maria Teresa Da Silva Felicio Scientifi c Cooperation and Assistance,  

Zoonoses (Data Collection) Unit

Ms Rita De Bon

Risk Assessment, Biological Hazards Unit (BIOHAZ)

Dr Hubert Deluyker

Director of  Scientifi c Cooperation and Assistance

Dr Marta Hugas

Risk Assessment, Biological Hazards Unit (BIOHAZ)

Dr Ernesto Liebana

Risk Assessment, Biological Hazards Unit (BIOHAZ)

Dr Pia Makela

Dr Alessandro Mannelli

Scientifi c Cooperation and Assistance,  
Zoonoses (Data Collection) Unit

Scientifi c Cooperation and Assistance,  
Zoonoses (Data Collection) Unit

Ms Francesca Piombini

Communications, Public Information & Events Unit

Dr Valentina Rizzi

Scientifi c Cooperation and Assistance,  Zoonoses 
(Data Collection) Unit

Dr Tobin Robinson

Risk Assessment, Biological Hazards Unit (BIOHAZ)

Ms Barbara Rotovnik

Communications, Public Information & Events Unit

Dr Eirini Tsigarida

Risk Assessment, Biological Hazards Unit (BIOHAZ)

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

61.

 
62.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

ANNEX 3: PRESENTATIONS OF SPEAKERS

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

63.

64.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Welcome and introduction to EFSA

MARTA HUGAS
Head of the Biological Hazards Unit

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

65.

Creation of EFSA: Three main goals

Improving EU food safety

Make a signifi cant 
contribution to:

Re-building consumer confi dence 
in EU food safety

Re-building confi dence of trading 
partners in the EU food supply

Creation of the EFSA: guiding principles

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 Independence

 Scientifi c excellence: 

 (cid:3)

 (cid:3)

Best experts throughout the EU and beyond

Stick to the food safety science

 Openness and Transparency

 Responsiveness  

Scientifi c Priority Objectives

 (cid:2)

Provide scientifi c opinions and advice to the European Commission, the European 
Parliament and the Member States

 (cid:3)

 (cid:3)

Applications

General opinions

 (cid:2)

Enhance risk assessment methodologies and other scientifi c activities

 (cid:3)

 (cid:3)

Establish Guidance documents

Methodology development

66.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 3 

  Presentations of speakers

Risk assessment: Scientifi c Panels

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

Panel on dietetic products, nutrition and allergies (NDA)

Panel on food additives & nutrient sources (ANS)

Panel on food contact materials, enzymes, fl avourings (CEF)

Panel on contaminants in the food chain (CONTAM)

Panel on biological hazards (BIOHAZ)

Panel on Animal health and welfare (AHAW)

Panel on additives and products or substances used in animal feed (FEEDAP)

Panel on Genetically Modifi ed Organisms (GMO)

Panel on plant protection products and their residues (PPR)

Panel on planth health (PLH)

Risk assessment: Overview on workfl ow of scientifi c opinions

Receipt of 
request

Assessment

 (cid:2)

Accepted mandates (Register of Questions)

 (cid:2)

Names of panel and working group members

 (cid:2)

Declaration of interest of experts

 (cid:2)

Agendas of the panel’s plenary meetings

 (cid:2)

 Minutes of the panel’s plenary

 (cid:2)

 Minutes of working group meetings

Adoption and 
Communication

 (cid:2)

 Adopted opinions

 (cid:2)

 Press releases and web stories

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

67.

 
Communications

Services and outputs

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

Europe-wide Reference service largely via website: 

www.efsa.europa.eu

Timely and accurate public announcements on risk assessments and key EU-wide issues

Accessible and relevant messages on food safety issues

Consistent and targeted output by close co-ordination with Member States

Scientifi c cooperation and assistance (SCA): Modus operandi

 (cid:2)

 (cid:2)

 (cid:2)

Not Risk Assessments - Remit of Panels (exception pesticides)

SCA operates through networks - 
with representation of all Member States 

Shared best practices with Scientifi c Panels

 (cid:3)

 (cid:3)

 (cid:3)

Working groups: Selection of Experts

Transparency: Declaration(s) of Interest 

Openness: Reports on the web

Scientifi c Cooperation and Assistance: Data collection activities

 (cid:2)

Data Collection 

 (cid:3)

 (cid:3)

For Scientifi c Opinions of high quality and Monitoring

Operating Procedures developed

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

68.

Data collection on food consumption

Data collection on chemical occurence

Data collection on pesticide residues

Emerging risks: new unit established

 (cid:3)

 (cid:3)

RASFF analysis 

Hazard Databases

Data collection on Zoonoses

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 3 

  Presentations of speakers

Notifi cation rates of human zoonoses in EU - 
Community Summary Report draft 2007

Courtesy, ECDC. Draft Community Summary Report on Zoonoses (CSR) 2007

s
e
s
o
n
o
o
Z

Campylobacteriosis
No conf. cases = 200,499

Salmonellosis
152,145

Yersiniosis
8,791

VTEC
2,801

Listeriosis
1,557

Echinococcosis
834

Trichinellosis
780

Brucellosis
542

Mycobacteria bovis
117

Lyssavirus
3

60

50

40

30

20

10

0

,

n
o
i
t
a
l
u
p
o
P
0
0
0
0
0
1
r
e
p
s
e
s
a
C
d
e
m
r
fi
n
o
C

0

5

10

15

20

25

30

35

40

45

50

2004

2005

2006

2007

Notification rate per 100,000 population

Year

Campylobacteriosis: most 
frequently reported zoonoses 
in humans in EU  

Reported incidence rate
stable, data 17 countries 

Campylobacter in broiler fl ocks in EU 2004-2007 - 
Community Summary Report draft 2007

)

%

(
e
c
n
e
l
a
v
e
r
p
d
e
t
h
g
e
W

i

s
k
c
o
fl
r
e

l
i

o
r
b
n

i

r
e
t
c
a
b
o
l
y
p
m
a
C
f
o

0
0
1

0
8

0
6

0
4

0
2

0

2004

2005

2006

2007

Year

Data from 9 MS, prevalence generally high, no trends apparent … 

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

69.

 
 
 
 
 
 
 
 
 
 
 
 
Campylobacter in broiler fl ocks 2004-2007 - 
Community Summary Report draft 2007

s
k
c
o
fl
r
e

l
i

o
r
b
n

i

r
e
t
c
a
b
o
l
y
p
m
a
C
f
o
)

%

(
e
c
n
e
l
a
v
e
r
P

80

60

40

20

0

80

60

40

20

0

2004 

2005 

2006 

2007

2004 

2005 

2006 

2007

Austria

Denmark

Italy

Germany

80

60

40

20

0

80

60

40

20

0

2004 

2005 

2006 

2007

2004 

2005 

2006 

2007

… but, substantial variation between reporting MS

2005 - BIOHAZ Opinion - Conclusion

Opinion of the Scientifi c Panel on Biological Hazards related 
to Campylobacter in animals and foodstuff  s
(Question N° EFSA-Q-2003-081) - Adopted on 27th of January 2005

Source of risk

 (cid:2)

Poultry meat products - major source through

 (cid:3)

 (cid:3)

 (cid:3)

Cross contamination to ready-to-eat food

Direct hands-to-mouth transfer during food preparation

Consumption of undercooked poultry meat (lesser extent)

 (cid:2)

 (cid:2)

 (cid:2)

70.

Meat from pigs and ruminants - low risk to consumers except for undercooked off al

Raw milk and contaminated drinking water

Bivalve molluscs

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

 
 
 
 
 
 
 
 
 
 
Annex 3 

  Presentations of speakers

2008 - Request for a BIOHAZ opinion

Quantitatively update the 2005 Opinion related to Campylobacter in animals 
and foodstuff  s as regards broiler meat production (Gallus gallus)
(Question No EFSA-Q-2008-469) 

 (cid:2)

 (cid:2)

 (cid:2)

The extent to which meat derived from broilers contributes to human 
campylobacteriosis at EU level. 

Identify and rank the possible control options within the broiler meat production 
chain 

Propose potential targets at diff erent stages of the food chain to reduce the 
prevalence of human campylobacteriosis in the EU caused by broiler meat 
consumption or cross-contamination. 

EU-wide baseline survey on Campylobacter in broilers

 (cid:2)

Fully harmonised, well designed survey across the EU Member States 
carried out in 2008

 (cid:2)

The survey covers 

 (cid:3)

 (cid:3)

Campylobacter 

prevalence in broilers (ceacal samples) and 

Salmonella
on broiler carcasses at slaughterhouse

 and Campylobacter prevalence + quantitative data 

 (cid:2)

EFSA will receive the data in March 2009:

 (cid:3)

 (cid:3)

the report A (on prevalence estimates) to be published on 31.1.2010 and 

report B (on risk factors) on 30.4.2010 

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

71.

 
72.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

New approaches to source 
attribution: their role in reducing 
campylobacteriosis notifi cations 
in New Zealand

NIGEL FRENCH
Massey University, New Zealand

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

73.

Outline

 (cid:2)

Epidemiology

 (cid:3)

Recent studies of human case data

 (cid:2)

Genotyping – human and animal reservoirs

 (cid:3)

MLST

 (cid:2)

 (cid:2)

Source attribution modelling

Recent trends – post intervention

Source: ESR

74.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 3 

  Presentations of speakers

Campylobacteriosis in New Zealand

From Baker et al. 2006

Epidemiology: seasonal pattern

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

75.

 
Epidemiology: spatial pattern

>1M popn

Wealthy area

Deprived area

76.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 3 

  Presentations of speakers

Spatial epidemiology - age

Pre-school children predominantly rural

School children predominantly urban

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

77.

 
Interventions in poultry industry demanded

Poultry ~ 40% of meat consumption

Source attribution

Essential for:

 (cid:2)

 (cid:2)

 (cid:2)

Managing public health risks

Prioritising resources

Directing research eff ort

Approaches to ‘source attribution’

 (cid:2)

(Analytical) epidemiology

 (cid:3)

Population-based epidemiological studies 

Simulation modelling / Risk assessment 

Molecular epidemiology

 (cid:2)

 (cid:2)

 (cid:3)

 (cid:3)

Microbial subtyping / source tracking

Applying molecular tools, population genetics and 
epidemiological modelling to inform public health policy

 (cid:3)

NZFSA and industry funded

78.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 3 

  Presentations of speakers

(Analytical) epidemiology

Population-based epidemiological studies

 (cid:2)

 (cid:2)

Cross-sectional, cohort, case-control, case-case.

Can estimate relative risk / odds ratios / PAF for diff erent exposures 

 (cid:3)

Campylobacter and eating poultry, foreign travel, 

e.g. 
environmental, occupational

Source/ 
exposure

 (cid:2)

Issues with case-control studies

disease

 (cid:3)

 (cid:3)

 (cid:3)

Can be very valuable but…

Prone to reporting bias

 -

“I must have eaten chicken….”

If high level immunity, similar exposures in cases and controls – low power

Chicken – confusing / confl icting evidence?

Ikram 1994, New Zealand Campylobacter study

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

79.

 
Simulation (RA) modelling 

Multiple pathways / exposures

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

Food and environmental sources

Simulation of propagation of pathogen along pathway

Hazard or risk based (need D-RR)

Good for assessing interventions

Environment

Food

exposure

disease

NIWA/ESR model

80.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 3 

  Presentations of speakers

Molecular epidemiology

 (cid:2)

 (cid:2)

Microbial subtyping / source tracking

Applying molecular tools, population genetics 
and epidemiological modelling to inform public health policy

 (cid:2)

NZFSA funded

Multi Locus Sequence Typing 

 (cid:2)

 (cid:2)

 (cid:2)

PCR highly conserved genes

7 housekeeping genes

Use allelic variation to describe subtypes:

 (cid:3)

 (cid:3)

ST = sequence type – unique pattern of 7 alleles

Clonal complex = group of related STs identifi ed by progenitor ST

tkt gly A

unc A

pgm

glt A

1.6Mbp

asp A

gln A

 (cid:2)

Website: Oxford University
http://campylobacter.mlst.net

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

81.

 
Campylobacter populations 

Minimum spanning tree of all known isolates on PubMLST website 
2954 STs, ~5000 isolates

ST-353

ST-682
ST-177

ST-257

ST-403

ST-21
ST-61

ST-828 C. coli

ST-42

ST-45

82.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 3 

  Presentations of speakers

ST-61 complex

source

Frequency Percentage

human stool

cattle

sheep

ruminant off al/ 
meat

lamb

Chicken

62

53

17

8

8

3

35.2%

30.1%

9.7%

7.9%

4.5%

1.7%

New Zealand Manawatu study 2005-

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

Are human isolates the same as those found 
in diff erent sources?

Identify genotypes common to particular sources

Modelling (risk attribution)

Feasibility study: useful approach to embed 
within surveillance in NZ?

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

83.

 
Sampling

Numbers of samples/isolates:  C. jejuni

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

Human 

Poultry  

520 (770 samples)

562 samples   75% +ve

Red meat 

1312 samples  12% +ve

Ruminant faeces  278 samples  58% +ve

Env. Water 

335 samples  30% +ve

Wild bird 

192 samples  13% +ve

84.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 3 

  Presentations of speakers

MLST
Human cases in Manawatu

Rare internationally

Orange = Ruminant 
associated strains

Minimum spanning tree: isolates from the Manawatu

Poultry strains

Water strain

Ruminant 
strain

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

85.

 
Human cases over 3-year period 

ST 474

ST 48

ST 354

ST 190

ST 45
ST 45

86.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Host associated sequence types in New Zealand

d
e
t
a
i
c
o
s
s
a
t
n
a
n
m
u
R

i

Annex 3 

  Presentations of speakers

P
o
u
l
t
r
y
a
s
s
o
c
i
a
t
e
d

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

87.

 
 
 
88.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 3 

  Presentations of speakers

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

89.

 
90.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 3 

  Presentations of speakers

Case-case comparison

Chi sq 18.13, P<0.011
N=71 ruminant
N=394 poultry 

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

91.

 
Generalised outbreak

ST-474  and  ST-190  responsible
for  over  40%  of  2006  winter
outbreak cases… nationally

92.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 3 

  Presentations of speakers

Orange = human

Rest poultry

Auckland MLST (T. Wong)

Human

474

Auckland

Source attribution 

 (cid:2)

Molecular tools and modelling

 (cid:3)

Proportional similarity

 -

Area of overlap

 (cid:3)

Dutch model

 -

Simple deterministic assignment

 (cid:3)

Hald model

 -

Bayesian model assignment with uncertainty

 (cid:3)

Island model

 -

Population genetics approach

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

93.

 
Proportional Similarity Index (PS)

The PS estimates the area of overlap between the frequency distributions 
of e.g. bacterial sub types from diff erent sources.

The Hald model (Hald et al 2004)

Number of cases of type i 
attributable to food source j

λij = pij (Mjaj )qi

p (cid:2)

ij = matrix of prevalence of diff erent strain types 

M (cid:2)

j= relative amount of food consumed

a (cid:2)

j = relative ‘danger’ of food (or environmental) sources. 

q (cid:2)

i = relative ‘virulence’ of strains.  

Estimates number of cases with measure of uncertainty (Bayesian inference)

94.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 3 

  Presentations of speakers

Modifi ed Hald Model

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

Model prevalence uncertainty

Hierarchical model for bacterial parameters (q)

Exponential prior for source specifi c parameters (a)

Omit food consumption weights (M)

Include potentially pathogenic subtypes

Island model (Wilson et al 2008)

 (cid:2)

 (cid:2)

 (cid:2)

Population genetics approach 

Genealogical method based on ‘coalescent’

 (cid:3)

Cross-validation

Use MLST data in animal populations (“islands”) to estimate:

 (cid:3)

 (cid:3)

 (cid:3)

Mutation rates

Recombination rates

Migration rates (inter-host transmission)

 (cid:2)

From these estimate ‘migration’ into human population

 (cid:3)

Source attribution

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

95.

 
Source attribution in New Zealand: Island model 

D. Wilson, Lancaster University, UK

96.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 3 

  Presentations of speakers

Source attribution: comparing models

Attribution of 520 human cases 
in the Manawatu

Dutch model

Left column:  
Middle column:  modifi ed Hald model
Right column:  

Island model

Comparing models

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

PS index and Dutch models easy to compute

m. Hald and Island models include more of information from data – more complex

m. Hald model captures food and pathogen factors

Island model can assign all human cases

Therefore… recommend multiple, comparative approach…  

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

97.

 
Poultry industry intervention trials

Post spin-chill:

Tasker blue (Sulphuric acid and copper)

Sanova (ASC)

Pre spin chill:

Inspexx
(hydrogen peroxide and peroxyactic acid)

98.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 3 

  Presentations of speakers

Poultry – count data at retail

Company A

Company B

Company C

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

99.

 
Recent trends in New Zealand

NMD

Decline in 
carcase counts 
observed

Mandated 
standard and 
performance 
target set

100.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 3 

  Presentations of speakers

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

101.

 
Conclusions

 (cid:2)

New Zealand has unique epidemiology 

 (cid:3)

 (cid:3)

 (cid:3)

Rural ruminant exposure in young children

Urban poultry across all ages

Dominant strain: ST474

 (cid:2)

Source attribution modelling

 (cid:3)

 (cid:3)

Tools advanced in recent years

Applied to Campylobacter identifi ed food, particularly poultry, most important 
source, cattle second

 (cid:2)

 (cid:2)

Focussing on poultry  – early signs of success

Environmental exposures less well defi ned

 (cid:3)

 (cid:3)

May become more important 

Ruminants and wildlife

102.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 3 

  Presentations of speakers

Acknowledgements

 (cid:2)

Staff  - lecturers

 (cid:3)

Dr Eve Pleydell, Dr Deb Prattley

 (cid:2)

Postdocs / RAs

 (cid:3)

Dr Simon Spencer, 
Dr Jonathan Marshall, 
Dr Anne Midwinter, 
Dr Julie Collins-Emerson

 (cid:2)

Lab team:

 (cid:3)

Rebecca Pattison, Rukhshana Akhter, Errol Kwan, 
Lynn Rogers, Isabel Li, Jim Learmonth, Anthony Pita, 
Sarah Vaughan, 

NZFSA-funded

 (cid:2)

PhD students

 (cid:3)

Petra Mullner, Vathsala Mohan, 

 (cid:2)

Masters students

 (cid:3)

Particularly Tui Shadbolt….

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

ESR  - Phil Carter, Sharla McTavish 

AgResearch – Grant Hotter 

CDRP team 

 (cid:3)

 (cid:3)

 (cid:3)

NIWA – Graham McBride

ESR – Rob Lake

NZFSA – Peter van de Logt

Palmerston North Hospital / MedLab

Massey – IMBS, IFNHH, IFS

 (cid:3)

Allan Wilson Centre

Universities of Liverpool, Lancaster, Oxford

Industry

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

103.

 
104.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Campylobacter Risk Assessment 
in the EU: 
Past, present and future.

MAARTEN NAUTA
RIVM, The Netherlands

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

105.

Overview

 (cid:2)

Past

 (cid:3)

MedVetNet WP 24: a comparison of 
assessments” in Europe 

“Campylobacter in broiler meat risk 

 (cid:2)

Present

 (cid:3)

A consensus framework: CRAF

 (cid:2)

Future

 (cid:3)

Challenges of European

 Campylobacter QMRA

Risk assessment: what do I mean?

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

Food chain risk assessment

Model describes transmission and survival 
of Campylobacter in the broiler meat chain: 
changes in distribution of concentrations

Exposure assessment
+ Dose response = risk

Quantitative Microbiological 
Risk Assessment (QMRA) 
is still developing!

  scalding
  defeathering
  evisceration
  washing
  chilling

  breast cap
  double filet
  filet

Farm

Processing

Cutting

Storage

Consumer 
preparation

Ingestion /  
Dose response

106.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 3 

  Presentations of speakers

Why we need risk assessment

 (cid:2)

Relative

 risk estimates

 (cid:3)

 (cid:3)

The eff ects of control measures

Comparison of interventions all over the food chain

 (cid:2)

Added value

 (cid:3)

 (cid:3)

 (cid:3)

 (cid:3)

food chain data

epidemiology

below the detection limit

check our understanding

 (cid:2)

Indispensable for PO / target setting 

Campylobacter in broiler meat risk assessments in Europe

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

UK 

Hartnett  

2001

Denmark 

Rosenquist, Christensen 

2003

Netherlands  Havelaar, Nauta 

Germany 

Brynestad 

Belgium 

Uyttendaele 

Gellynck, Messens 

Sweden 

Lindqvist, Lindblad 

Italy   

Calistri, Giovannini 

2005

2006

2006

2008

2008

2008

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

107.

 
 
 
 
 
 
 
 
 
MedVetNet Workpackage 24 
March 2006 - June 2009

 (cid:2)

 (cid:2)

Objective: consensus on 

Campylobacter QMRA?

UK, DK, GE, NL models compared

 (cid:3)

Input from New Zealand and FAO/WHO risk assessment

 (cid:2)

Diff erences

 (cid:3)

 (cid:3)

 (cid:3)

 (cid:3)

objectives

approach

models

results

 (cid:2)

Similar conclusions

UK 

Denmark 

Netherlands 

Germany

DK 

NL 

D

Farm

Processing

Consumer + 

DR

108.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 3 

  Presentations of speakers

Diff  erent objectives

 (cid:2)

 (cid:2)

 (cid:2)

Gain risk assessment modelling experience

Human incidence estimation

Evaluation of risk reduction after intervention and control

 (cid:3)

 (cid:3)

 (cid:3)

general

specifi c interventions

incl. economic analysis

 (cid:2)

Interaction with risk management

Diff  erences between models

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

objectives

expertise of modellers

national diff erences

data and/or expert opinion

statistical description and/or dynamic model

details included in the models

channel assignment

end product 

 (cid:3)

 (cid:3)

 (cid:3)

whole carcass

specifi c product

side dish

 (cid:2)

but all use quantitative risk assessment 

 (cid:3)

probabilistic models 

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

109.

 
Diff  erences between model results 
example

7

6

5

4

3

2

1

0

)
n
e
k
c
i
h
c
/
u
f
c
g
o
l
(
n
o
i
t
a
r
t
n
e
c
n
o
C

DK

NL

UK

input

scalding

defeathering

evisceration

washing

chilling

Three chicken processing models with the same input

 (cid:2)

 (cid:2)

 (cid:2)

diff erent dynamics

similar end results

similar eff ects of interventions (?)

110.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

 
 
Annex 3 

  Presentations of speakers

Diff  erent end results ?

 (cid:2)

Varying human incidence estimates

 (cid:3)

 (cid:3)

 (cid:3)

Diff erences in models, (national) data and assumptions

Risk estimates are uncertain

Not easy to decide what is the “main cause” of diff erences in results

 (cid:2)

Evaluation of risk reduction after intervention

 (cid:3)

 (cid:3)

In general similar, despite quantitative diff erences

Relative risk estimates are less uncertain

Similar conclusions (1)

 (cid:2)

Farm models predict many low prevalent fl ocks at the farm that may not be detected

1.0

0.8

0.6

0.4

0.2

e
c
n
e
l
a
v
e
r
p
k
c
o
fl
-
n
h
t
i

i

W

0.0

0

UK
NL

5

10

15

20

25

Age of birds (days)

source: Nauta et al IJFM in press

 (cid:2)

False negative fl ocks occur frequently

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

111.

 
 
Similar conclusions (2)

 (cid:2)

“Logistic slaughter” has little eff ect 

 (cid:3)

 (cid:3)

No growth of

 Campylobacter in processing environment

Each model MUST predict that concentrations on carcasses of cross contaminated 
fl ocks are lower

 (cid:2)

Data:

 (cid:3)

 (cid:3)

Typing shows
(e.g. Miwa et al. 2003)

 Campylobacters are transmitted from one fl ock to the other 

Transferred quantities are small (Johannessen

 et al. 2007 )

Similar conclusions (3)

 (cid:2)

High concentrations pose the largest risks

consumer + DR models

Christensen

Mylius

Brynestad

FAO/WHO

Data + DR

l
l
i
_
P

7%

6%

5%

4%

3%

2%

1%

0%

0 

1 

2 

3 

4 

5 

6 

7

Concentration on product at retail (log cfu / g)

Nauta et al, unpublished results

 (cid:3)

 (cid:3)

 (cid:3)

targetting high concentrations is an eff ective intervention 

get data on distributions of concentrations, not just means

confi rmed by Callicott

 et al. (2008)

112.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 3 

  Presentations of speakers

Conclusions from WP 24

 (cid:2)

QMRA model must be fi t for purpose

 (cid:3)

 (cid:3)

diff erent purposes require diff erent models

balance between simple and complex

 (cid:2)

Many modelling methods explored

 (cid:3)

try to combine the good qualities of diff erent models

 (cid:2)

Similar conclusions !

 (cid:3)

useful insights for risk managers

 (cid:2)

No consensus European Risk assessment Model

 (cid:3)

no single purpose, many national diff erences

 (cid:2)

Towards a consensus Approach 

 (cid:3)

development of

 Campylobacter Risk Assessment Framework (CRAF) 

Campylobacter Risk Assessment Framework CRAF

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

Software tool for risk assessors

Structured information on fi ve Campy QMRAs

Compare and link models for modules

An aid to make your own Campylobacter QMRA

INVITATION

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

113.

 
New Campylobacter QMRA in Europe (1)

 (cid:2)

 (cid:2)

Baseline data from caeca and neck skins

Challenge: how to relate those data to risks?

 (cid:3)

 (cid:3)

QMRA models don’t have either of them as inputs

Data don’t always show a good link caecal samples - meat products; why not?

)
g
/
u
f
c
g
o
l
(
s
t
e

l
l

fi
t
s
a
e
r
b

2

1.5

1

0.5

0

-0.5

-1

0

1

2

3

4

5

6

7

8

9

10

caecal samples (log cfu/g)

product

caeca

-

17

4

-

+

tot 21

+ tot

19

22

41

36

26

62

source: Nauta, Bolder et al, in prep.

114.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

 
 
 
Annex 3 

  Presentations of speakers

New Campylobacter QMRA in Europe (2)

 (cid:2)

Target setting: link with human health risks

  scalding
  defeathering
  evisceration
  washing
  chilling

  breast cap
  double filet
  filet

Farm

Processing

Cutting

Storage

Consumer 
preparation

Ingestion /  
Dose response

Data

Quantitative distribution

Diff erences between 
Member States

Process

Risk

 (cid:2)

Challenge:  

 How to model the diff erences for each MS?  
How important are those?

Take away messages

 (cid:2)

Campylobacter QMRA experience in Europe,

Much 
but

 (cid:3)

 (cid:3)

still

 (cid:3)

diff erent objectives and approaches

diff erent results

similar and useful conclusions

 (cid:2)

European 

Campylobacter QMRA needs

 (cid:3)

 (cid:3)

a clear objective

further development of QMRA modelling

 -

integration of good ideas

 -

balance between complexity and simplicity

 -

incorporation of diff erences between MS

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

115.

 
 
 
116.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Fluoroquinolone resistant 
Campylobacter
Epidemiology and risk assessment 

FRANK M. AARESTRUP
CRL Antimicrobial Resistance
National Food Institute, Denmark

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

117.

Campylobacter jejuni/coli

 (cid:2)

 (cid:2)

 (cid:2)

Primary foodborne pathogen in most developed and developing countries

Few specifi c control strategies available

Antimicrobial resistance a growing concern

Zoonoses in Denmark

118.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 3 

  Presentations of speakers

Sources of campylobacteriosis

Campylobacteriosis incidence in Belgium

Dioxin crisis
Dioxin crisis

1000
900
800
700
600
500
400
300
200
100
0

s
e
s
a
c
d
e
r
e
t
s
i
g
e
R

April

May

June

July

1998

1999

Data: Dr. Frank van Loock

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

119.

 
 
The basics

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

Most or second most common zoonoses

Most studies have indicated poultry as the main reservoir

Resistance mediated by mutations in gyrA

 (cid:3)

 (cid:3)

 (cid:3)

Ala-70 to Thr

Thr-86 to 

Ile, Lys, Ala, Val

Asp-90 to Ala, Asn, Tyr

Thus, spread of resistance is with the clone

Large clonal instability – diffi  cult to determine the spread

Fluoroquinolone resistance in Campylobacter

16

14

12

10

8

6

4

2

0

e
c
n
a
t
s
i
s
e
r

%

1982

1987

1989

Human 

Poultry

Endtz et al. 1991

120.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

 
Annex 3 

  Presentations of speakers

100

80

60

40

20

0

Thailand
Spain (1986)

Austria (1992)

France (1991)
Netherlands (1987)

Finland (1992)

Italy (1989)

United States (1995)

UK (1993)
Denmark (1993)

1999

1996

1993

1990

Campylobacter FQ -resistance epidemiology

Primary production

Slaugtherline
and food product

Human gut or skin

Infection in humans

Clone

Clone

Clone

Clone

e
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f

Selection by antimicrobials

Selection by biocides

Selection by antimicrobials

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

121.

 
 
 
 
 
 
 
 
 
 
 
7
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Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

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Annex 3 

  Presentations of speakers

Usage – resistance relationships

e
c
n
a
t
s
i
s
e
R

Exposure

Usage

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

123.

 
Exposure and dose-response 
just as for all other Campylobacter

Consequences

Approx. 2-3 days additional illness

124.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 3 

  Presentations of speakers

Part conclusion

 (cid:2)

 (cid:2)

 (cid:2)

Use of FQ selects for resistance

Exposure and infectivity as for other 
(NB patients in ciprofl oxacin treatment)

Campylobacter 

Consequences 2-3 days additional illness 

FDA Fluoroquinolone-Resistant
Campylobacter Risk Assessment

 (cid:2)

 (cid:2)

 (cid:2)

To determine the feasibility of estimating risk to human health

Possible regulatory tool for assessing future risks

Possible tool for establishing regulatory “triggers” based on surveillance

http://www.fda.gov/cvm/default.htm

Fluoroquinolone resistant Campylobacter in poultry

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

FDA-CVM / Vose2000

This model relates a number of contaminated 
carcasses N consumed domestically to the 
number of illnesses I that resulted.

It then predicts that for a future number 
of contaminated carcasses n, there will be 
i infections where: i=n*(I/N)

Model assumes that practices after 
production remain the same, but 
has some ability to make corrections

Model ends up with exactly the same 
behaviour as the Danish model!

Section 1
Campylobacter culture 
confirmed cases observable
in US population

Section 2
Total number of
Campylobacter infections in 
year in US population

Section 3
Number of those with
Fluoroquinolone-resistance
from chickens and
administered
Fluoroquinolone

Section 4
Number of Fluoroquinolone
resistant Campylobacter 
contaminated chicken
carcasses consumed in year

Section 5

Using the model to manage risk.
Measuring the level of risk.
Controlling the risk.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

125.

 
Symbol

Description

Formula

Section 1

Expected nominal number of observable 
confi rmed cases

nUS
nFN
oi

oe

λi

λe

US population

FoodNet catchment population

FoodNet observed invasive cases of 
Campylobacter

FoodNet observed enteric cases of 
Campylobacter

Data

Data

Data

Data

Expected observed FoodNet invasive cases of 
Campylobacter

=Gamma(oi,1)

Expected observed FoodNet enteric cases of 
Campylobacter

=Gamma(oe,1)

Ni (= N1i)

Nominal observed mean invasive infections in 
population

=λi * nUS / nFN

Ne

pb

N1eb

N1en

Nominal observed mean enteric infections in 
population

=λe * nUS / nFN

Proportion of enteric infections with bloody 
diarrhea 

Beta distribution based 
on data

Nominal mean number of confi rmed enteric 
infections in population with bloody diarrhea 

=Ne* pb

Nominal mean number of confi rmed enteric 
infections in population with non-bloody 
diarrhea 

=Ne*(1- pb)

Section 1

Section 2

Section 3

Section 4

Section 5

126.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 3 

  Presentations of speakers

1998

1999

0

2

4

6

8

10

12

14

16

18

20

22

24

26

Nominal mean number of fluoroquinolone-resistant Campylobacter cases 
affected by the resistance (thousands)

What is an acceptable level of risk?

Example Assumptions - FDA Risk Assessment

 (cid:2)

 (cid:2)

 (cid:2)

Fluoroquinolone resistance (after removal of travelers, those who took a 
fl uoroquinolone prior to culture and those for whom the time of taking the 
fl uoroquinolone was unknown) is attributed to chickens

The incidence rates for culture-confi rmed
catchment are representative of incidence rates for culture-confi rmed Campylobacter 
infections in the United States.

 Campylobacter infections in the FoodNet 

The CDC study estimate on number of stool samples taken at the doctors offi  ce as 
remembered by the patient (18%) was better than the estimate as remembered by 
the doctor (78%).

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

127.

 
Quinolone resistance among pathogenic Campylobacter

25

20

15

10

5

0

e
c
n
a
t
s
i
s
e
r

t
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c
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450

400

350

300

250

200

150

100

50

0

n
o
i
t
p
m
u
s
n
o
C

1996 

1997 

1998 

1999 

2000 

2001

Enrofloxacin

Broiler (c. jej)

Pigs (C. coli)

Ciprofl oxacin resistance among Campylobacter 
from chicken breast in US

35

30

25

20

15

10

5

0

2002

2003

2004

2005

2006

128.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

C. coli
C. jejuni

 
Annex 3 

  Presentations of speakers

In conclusion

 (cid:2)

FQ selects for resistance

 (cid:2)

 (cid:2)

 (cid:3)

The eff ect of diff erent treatment regimes has not been determined

It is possible to model the expected number of cases and additional eff ects

 (cid:3)

Requires a lot of data and money to generate those data

The eff ect of withdrawal not well documented (however, continuing must be 
expected to be worse)

The solution

 (cid:2)

Ban all use of fl uoroquinolones?

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

129.

 
Or 1.333

Or 19,000

f and r already included in the estimate of K

130.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 3 

  Presentations of speakers

10.45 / 5 = 2.09
5.45 / 5 = 1.09

Diff . 10 x higher load of
Campylobacter from
AS positive fl ocks

Actual numbers:

Positive:   123 + 182 + 776 + 36 + 49 =  1166 / 5 = 233

Negative:      1 + 0 + 1259 + 200 + 0 =   1460 / 5 = 292

Diff . 1,25 x higher load from AS negative fl ocks

Or -1,25

Or 1,333

Or -1,25

Or 19,000

f and r already included in the estimate of K

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

131.

 
Conclusions Cox & Popkten

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

Some mistaken factors and numbers

No uncertainty estimates

Numbers could be looked at diff erently

Useful for pointing out that potential benefi ts might also arise from the use of 
antimicrobials to animals

132.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Measures to control Campylobacter 
in broilers and broiler meat 

HANNE ROSENQUIST
Technical University of Denmark

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

133.

Report of Expert Consultation 

www.vet.dtu.dk/Default.aspx?ID=8561

Talk outline

 (cid:2)

Recommendations from an Expert Consultation 
on interventions to control Campylobacter in the broiler production 

 (cid:3)

 (cid:3)

pre-slaughter measures

post-slaughter measures

 (cid:2)

Experiences from EU countries which have implemented interventions

 (cid:3)

 (cid:3)

 (cid:3)

implemented interventions

changes in prevalence of broiler fl ocks

changes in number of human cases

 (cid:2)

Conclusions

134.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 3 

  Presentations of speakers

Thanks to 

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

Ingrid Hansson

Mats Lindblad

Merete Hofshagen

Gro Johannessen

Sigurborg Dadadottir

Jarle Reiersen

Jaap Wagenaar

Maarten Nauta

Wilma Jacobs-Reitsma

Nico Bolder

Andy Hill

Viv Allen

Frieda Jørgensen

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

Mark Berrang

Peter van der Logt

Steen Nordentoft

Anne Wingstrand

Birthe Hald

Ole Heuer

Flemming Bager

Helle Sommer

Bjarke Christensen 

Birgitte Borck 

Louise Boysen

Aim of expert consultation

 (cid:2)

 (cid:2)

to provide information and recommendations on the most useful interventions in 
the broiler production for reducing the human exposure to Campylobacter 

to facilitate and guide the decision-making for a new Danish fi ve-year action plan for
Campylobacter in broilers and broiler meat

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

135.

 
 
Experts were asked 

 (cid:2)

 (cid:2)

 (cid:2)

To identify and discuss the pros and cons of diff erent intervention methods,
 before, at and post slaughter

To evaluate interventions in terms of eff ect, cost, applicability, 
and consumer acceptability

To prioritise and evaluate the interventions they believed to be most useful 
under Danish conditions

The conclusions of the expert consultation are, therefore, not necessarily applicable in 
other countries where the Campylobacter prevalence in broilers is diff erent to that of 
Danish broilers or where diff erent legislation applies, e.g. legislation on the use of 
chemical decontaminants. 

Interventions before slaughter 

 (cid:2)

Two categories relating to 

mechanism

1. 

Interventions aimed at preventing fl ocks from being colonized

2. 

Interventions aimed at reducing the concentration of
chicken gut after colonization

 Campylobacter in the broiler 

136.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 3 

  Presentations of speakers

Intervention

Prevents 
colonization 
of fl ocks

Reduces 
concentration 
in gut

Ready 
to 
implement

Needs 
further 
development

Biosecurity

Farm/farmer hygiene
Environment around 
broiler houses
Insect control (fl y screens)

Slaughter broilers young

Thinning 

Drinking water / 
feed additives 
Organic acid, lactictic acid 
bacteria caprylic acid, …

Phage therapy 

Bacteriocins 

Vaccination

Genetic resistance -broiler 
breeds able to clear campy

Water supply quality 
(chlorinated, UV)

Reduced presence of other 
animals

+

+

+

+

+

+/-

-

-

+

+

+

+

-

-

-

-

-

+

+

+

-

-

-

-

+

+

(+)

+

+

+/-

-

-

-

-

+

+

-

-

+

-

-

+

+

+

+

+

-

-

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

137.

 
Interventions before slaughter 
- given a high score 

Intervention

Biosecurity

Pros

Cons

Farm/farmer hygiene

Applicable, effi  cient,

Consistent compliance?

Environment around 
broiler houses

Insect control (fl y screens)

low costs

No guarantee of free fl ocks

Good eff ect –if other biosecurity 
measures are in place, relatively 
low costs

Not commercially available

Slaughter broilers young 
(31-33 days)

Applicable
Eff ective in Iceland

Relatively costly
Not always possible if a special 
size is required

Thinning – hygiene 
precautions by catchers

Production more profi table
Possibility of diff erent bird sizes

Diffi  cult to thin without causing 
breach of biosecurity

Interventions before slaughter 
- given a low score

Intervention

Drinking water / feed additives
Organic acid, bacteria, caprylic 
acid, probiotics,fatty acids, …

Pros

Easy to apply
Relatively cheap

Phage therapy

Documented eff ect 

Cons

No clear indication that these work 
effi  ciently
May need legal changes
Needs further investigation

Reduction of Campylobacter may 
be short lived – development of 
resistance
Needs further development

Bacteriocins 

Vaccination 

Genetic resistance – broiler 
breeds able to clear campy

Water supply quality 
(chlorinated, UV)

Documented eff ect under 
experimental conditions

Needs legal changes
Needs further investigation

Could be good 

Could be good 

Needs investigation

Needs investigation

Documented eff ect 

Diffi  cult to maintain

Reduced presence of other 
animals

Evidence that it is a risk 
factor

Diffi  cult to change on current 
farms, but relevant in relation to 
location and design of new farms

138.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 3 

  Presentations of speakers

Interventions before slaughter 
- prioritized interventions

 (cid:2)

 (cid:2)

 (cid:2)

Biosecurity measures in and around farms

Fly screens

Improved procedures re thinning of fl ocks

Biosecurity – farm/farmer hygiene

Ante-room 

Empty period, proper cleaning

Biosecurity – environment around broiler houses

Vegetation free zone

Drained zone

Dust free zone

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

139.

 
 
 
Biosecurity – insect control, fl y screens

140.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 3 

  Presentations of speakers

% Campylobacter positive fl ocks at slaughter
June - November 2003-5 and 2006 

Fly screen houses

Control houses

70

60

50

40

30

20

10

0

2003-5 Historical data

2006 Fly screen study

Hald et al. 2007

Interventions at slaughter 

 (cid:2)

Two categories:

1. 

Hygienic measures

 - interventions aimed at reducing fecal contamination (GMP)

2. 

Decontamination

 - interventions aimed at reducing the concentration on carcasses

 ·

 ·

 (acidified sodium chlorite, chlorine, chlorine dioxide, 
Chemical
trisodium phosphate, cetylpyridinium chloride, ozone, and peroxy acids)

 (freezing, crust freezing, steam-ultrasound, steam/hot water, 

Physical
forced air chilling, heat treatment, irradiation)

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

141.

 
Interventions at and after slaughter 
- given a high score

Intervention

Pros

Cons

Scheduled slaughter
followed by decontamination 
of positive fl ocks or 
production of safe to handle 
products (e.g. oven-ready or 
ready-to-eat)

Physical decontamination
 that leaves the meat fresh
Steam-ultrasound

Crust freezing

Forced air chilling

Steam or hot water

Marinating – low pH 
together with food 
ingredients

Proven eff ect
May be based on past 
performance to limit testing
Production of safe to handle 
products may be cheap

Pre-slaughter testing, expensive, 
needs a low prevalence
Needs a marked

Fairly eff ective, relatively 
low costs
Limited eff ect, may be 
combined with other methods
Limited eff ect, may be 
combined with other methods
Fairly eff ective

May be eff ective and cheap

New equipment
Needs further development
Relatively expensive

Relatively expensive

Diffi  cult to achieve success i.e. 
reduction while still maintaining 
product quality

Only for a limited production 
–needs a marked
More research needed

142.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 3 

  Presentations of speakers

Interventions at and after slaughter 
- given a low score

Intervention

Pros

Cons

Prevention of fecal leakage

May be eff ective (CARMA) No equipment developed

Chemical decontamination of 
all carcasses

Eff ective, relatively cheap Needs consumer acceptance

Substances needs approval and 
authorization

Not fresh meat, expensive
Risk of marked distortion
(opening to imports)

Expensive – many batches controlled

Physical decontamination 
of all positive fl ocks
Freezing
Heat-treatment

Eff ective

Name and shame - 
publicity exposing producers 
and companies, who produce/
sell highly contaminated 
products

Consumer information – 
labeling about Campy
Information on hygiene

Logistic slaughter – to avoid 
contamination from positive to 
negative fl ocks

Used in DK (case-by-case 
risk assessment), seems 
fairly eff ective
Transparency

Cheap
Relatively cheap

Effi  cacy uncertain
Eff ect minimal

Incentive for the industry 
to do something

Minimal eff ect, not feasible, expensive

Physical decontamination 
Irradiation

Very eff ective

Strong consumer resistance
Expensive

Interventions at and after slaughter 
- prioritized interventions

 (cid:2)

Channeling of fl ocks based on Campy history of producers to 

1. 

decontamination by methods that keep the meat fresh, chilled

2. 

Safe to handle products

 (cid:2)

Education, especially of children

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

143.

 
Implemented interventions in EU countries
EU Zoonosis report 2007 - Focus of the year 

Table 2. Specifi c measures within countries with Campylobacter control strategies, 2006

Year of implementation

2003

2004

2004

N.S.

1991

20032

2001

DK

FI

LT

ES

SE

UK

NO

Mandatory (+/-) 

Control measures

FARM

Biosecurity

- Personal hygiene

- Buildings

- Environment

Treatment of drinking water

Feed additives

ABATTOIR

Logistic slaughter

Freezing of meat from 
positive fl ocks

Heat treatment of meat 
from positive fl ocks

Improved GHP3

Removal of faecal 
contamination

Use of chemicals

RETAIL

Labelling

Leak-proof packaging

CONSUMERS

Education

-

√

√

√

√

÷

√

√

√

÷

÷

÷

÷

÷

√/÷

√

+

√

√

√

√

÷

÷

√

÷

÷

÷

√

÷

÷

÷

÷

-

√

√

√

√

÷

√

√

÷

√

√

√

÷

÷

√

√

-

√

√

√

√

√

N.S.

÷

N.S.

√

√

N.S.

N.S.

÷

÷

√

+

√

√

√

√

÷

÷

÷

÷

÷

√

÷

÷

÷

√

÷

-

√

√

√

√

÷

÷

÷

÷

÷

√

√

÷

√

√

√

+

√

√

√

√

√

÷

÷

√

√

√

√

÷

÷

√/÷

÷

144.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 3 

  Presentations of speakers

Broiler fl ock prevalences

EU Zoonosis report 2007

Denmark

Sweden

s
k
c
o
fl
r
e

l
i

o
r
b
e
v
i
t
i
s
o
p
t
n
e
c
r
e
p

45

40

35

30

25

20

15

10

5

0

s
k
c
o
fl
r
e

l
i

o
r
b
e
v
i
t
i
s
o
p
t
n
e
c
r
e
p

8

7

6

5

4

3

2

1

0

2005

2006

2002

2003

2004

Year

Finland

s
k
c
o
fl
r
e

l
i

o
r
b
e
v
i
t
i
s
o
p
t
n
e
c
r
e
p

s
k
c
o
fl
r
e

l
i

o
r
b
e
v
i
t
i
s
o
p
t
n
e
c
r
e
p

25

20

15

10

5

0

7

6

5

4

3

2

1

0

2002

2003

2005

2006

2004

Year

Norway

2002

2003

2004

Year

2005

2006

2002

2003

2004

Year

2005

2006

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

145.

 
 
 
 
 
 
 
 
 
 
 
 
 
Campylobacter in broiler meat 
at two largest Danish processing plants

l

s
e
p
m
a
s
e
v
i
t
i
s
o
p
%

g
/
u
f
c
0
1
e
v
o
b
a

25%

20%

15%

10%

5%

0%

2004

2005

2006

2007

Year

146.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

 
 
 
 
 
Annex 3 

  Presentations of speakers

0
0
5
4

0
0
0
4

0
0
5
3

0
0
0
3

0
0
5
2

0
0
0
2

0
0
5
1

0
0
0
1

0

0
0
5

reported campylobacteriosis cases 

i

a
n
a
u
h
t
i
L

6
0
0
2

5
0
0
2

4
0
0
2

r
a
e
Y

3
0
0
2

2
0
0
2

6
0
0
2

5
0
0
2

4
0
0
2

r
a
e
Y

i

a
n
o
t
s
E

3
0
0
2

2
0
0
2

0
0
9

0
0
8

0
0
7

0
0
6

0
0
5

0
0
4

0
0
3

0
0
2

0
0
1

0

reported campylobacteriosis cases 

0
0
0
8

0
0
0
7

0
0
0
6

0
0
0
5

0
0
0
4

0
0
0
3

0
0
0
2

0
0
0
1

0

0
4
1

0
2
1

0
0
1

0
8

0
6

0
4

0
2

0

reported campylobacteriosis cases 

reported campylobacteriosis cases 

6
0
0
2

5
0
0
2

4
0
0
2

r
a
e
Y

3
0
0
2

2
0
0
2

i

m
o
d
g
n
K
d
e
t
i
n
U

6
0
0
2

5
0
0
2

4
0
0
2

r
a
e
Y

3
0
0
2

2
0
0
2

6
0
0
2

5
0
0
2

4
0
0
2

r
a
e
Y

3
0
0
2

2
0
0
2

6
0
0
2

5
0
0
2

4
0
0
2

r
a
e
Y

3
0
0
2

2
0
0
2

0
0
0
5

0
0
5
4

0
0
0
4

0
0
5
3

0
0
0
3

0
0
5
2

0
0
0
2

0
0
5
1

0
0
0
1

0

0
0
5

0
0
0
0
6

0
0
0
0
5

0
0
0
0
4

0
0
0
0
3

0
0
0
0
2

0
0
0
0
1

0

reported campylobacteriosis cases 

reported campylobacteriosis cases 

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

147.

d
n
a
n
F

l

i

n
e
d
e
w
S

k
r
a
m
n
e
D

s
n
o
i
t
c
e
f
n

i

r
e
t
c
a
b
o
l
y
p
m
a
C
n
a
m
u
h
f
o
s
r
e
b
m
u
N

7
0
0
2
t
r
o
p
e
r

s
i
s
o
n
o
o
Z
U
E

 
 
 
 
 
 
 
 
 
Hypothesis of positive eff  ect in Denmark

Economical incentives

 (cid:2)

 (cid:2)

Rewarding farmers for compliance with industry code of practice

Rewarding farmers for delivering 

Campylobacter free fl ocks 

Conclusion

With the control measures available: 

 (cid:2)

 (cid:2)

It is possible to reduce (not eliminate) the occurrence 
of Campylobacter in broilers and broiler meat

And to reduce (slightly) the numbers of human

 Campylobacter infections

The Icelandic experience
fi gure borrowed from Sigurborg Dadadottir

148.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

ANNEX 4: PRESENTATIONS OF THE DISCUSSION GROUPS

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

149.

150.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Introduction to Discussion Groups

STEF BRONZWAER
EFSA

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

151.

Organisation

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

4 discussion groups

Looking for input from all

Free scientifi c debate

You received briefi ng notes

Discussion points: to allow effi  cient reporting 

 (cid:3)

 (cid:3)

Report back to plenary

Summary Report

Programme

 (cid:2)

Today: 14.00 – 18.00 

Discussion groups

 (cid:3)

Coff ee at 16.00 / Buff et 19.00 / Guided Tour 20.30

 (cid:2)

Tomorrow: 09.00 – 10.00  

Discussion groups

 (cid:3)

Finalise outcome of discussion

 (cid:2)

Tomorrow: 10.30 – 13.30 

Plenary Discussion

 (cid:3)

 (cid:3)

 (cid:3)

Expose groups’ work to plenary

Provide input to other groups

Conclude with overall discussion

Reporting outcome

 (cid:2)

Publish PPT-presentations of speakers opening session + short web-story (12 
December 2008)

 (cid:2)

Planning summary report

1 (cid:3) st review by DG chairs and rapporteurs (Jan 2009)
 (cid:3)

Advanced draft to all participants for comments (Feb 2009)

 (cid:3)

 (cid:3)

Publication of summary report on EFSA website (April 2009)

Later in EFSA Science Colloquium Report Series

152.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

 
Annex 4 

  Presentations of the Discussion Groups

Z
E
P
O
L
Z
E
N
T
R
A
M

I

i

o
n
o
t
n
A

L
L
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W
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N
e
n
a
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i

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q
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i

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a
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a
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a
d

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B
B
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Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

153.

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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154.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Annex 4 

  Presentations of the Discussion Groups

An EFSA Colloquium is NOT:

 (cid:2)

 (cid:2)

 (cid:2)

An attempt to agree on the details of a preferred  strategy

An exercise to defi ne a blue print for the work ahead of us

A “who is right - who is wrong” discussion

Instead an EFSA Colloquium is:

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

Platform for in-depth discussions on scientifi c approaches, 
methods available, and tools and data needed for conducting risk assessment

Event to explore opportunities and limitations

Opportunity to identify further (research) needs

Interactive !

Thank you for participating

Wishing you 

frank  

open and  

constructive discussions …

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

155.

 
 
 
 
 
 
 
 
 
 
 
 
 
156.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Discussion Group 1

Health impact and attribution 
of Campylobacter

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

157.

Discussion points

1. 

2. 

3. 

4. 

Assess the epidemiological evidence on human campylobacteriosis in the EU with a 
view to identify the extent of the contribution of foodborne infection. 

Consider the applicability of diff erent 
campylobacteriosis in the EU (as described in the BIOHAZ opinion Overview of 
methods for source attribution for human illness from food borne microbiological 
hazard).

approaches to source attribution for human 

data availability and propose additional data collection (special studies, 
Consider 
surveillance) in humans and in the food chain needed for source attribution, taking 
into account diff erences between Member States.

Identify possible approaches to establishing the 
discuss their applicability at national and EU level. 

degree of underreporting and 

1.  Assess the epidemiological evidence on human 

campylobacteriosis in the EU with a view to identify 
the extent of the contribution of foodborne infection. 

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

For those countries where a comprehensive and extensive public health surveillance 
systems are in place Campylobacter is recognised as the leading cause of bacterial 
zoonotic gastrointestinal illness (refer to ECDC and EFSA)

Results of epidemiological investigations in sporadic cases and outbreaks indicate 
the important contribution of Campylobacter to the burden of bacterial zoonotic 
illness

Substantial number of foodborne outbreaks caused by
years is observed in the Community Zoonoses Report

 Campylobacter in the last 

Population-based studies confi rm a high campylobacteriosis incidence in humans

Sero-surveillance studies confi rm the high exposure rate to
humans

 Campylobacter by 

Studies of burden of foodborne illness suggest that the burden associated to
Campylobacter infection is substantial particularly when compared with other 
pathogens that usually are foodborne

158.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

 
Annex 4 

  Presentations of the Discussion Groups

2.  Consider the applicability of diff  erent approaches to source 

attribution for human campylobacteriosis in the EU 
(as described in the BIOHAZ opinion Overview of methods 
for source attribution for human illness from food borne 
microbiological hazard). 

 (cid:2)

Microbial sub-typing. Some methods coupled with modelling have shown promising 
results for Campylobacter source attribution. 

 (cid:3)

 (cid:3)

 (cid:3)

 (cid:3)

 Further activities are needed to refi ne and combine diff erent methods (e.g.
MLST) to identify the most proper “markers” for source attribution purposes. 

 PFGE, 

 Further work is needed to develop and evaluate  models able to assess the 
contribution of diff erent sources. 

 Culture techniques and sampling procedures may bias the results for source 
attribution

 Attention should be given to the interpretation of  strains particularly in the 
environment (source vs vehicle)

 (cid:2)

Epidemiological studies 

 (cid:3)

 (cid:3)

 (cid:3)

 (cid:3)

Case-control studies of sporadic cases have provided useful information. 

However, they have limitations

 -

high degree of exposure and illness limit the applicability

 -

Prone to well known biases

 -

The interpretation of results may be a challenge (e.g.
cook sliced packed poultry meat as “protective” factor)

 consumption of ready to 

 The combination of this approach with the microbial sub-typing is 
recommended.

The use of spatial analysis methodology for exploring associate risk factors (e.g.
age distribution of human cases) may be of benefi t.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

159.

 
 
 (cid:2)

Outbreak investigation

 can give useful information on vehicles and pathways.

 (cid:3)

 (cid:3)

 (cid:3)

 It can not be directly used for source attribution studies, because the distribution 
of vehicles of sporadic and outbreak cases are unlikely to be the same.

 However it may give valuable information to better interpret the results of 
attribution studies, including information on contributing factors (cross-
contamination)  

 It can be hampered by the diffi  culties in obtaining a clear microbiological 
evidence of the responsible vehicle, but when it combines epidemiology and 
microbiology in a proper way it is a powerful tool. 

 (cid:2)

Assessment of interventions should ideally be carried out in the framework of 
controlled studies. 

 (cid:3)

 (cid:3)

 (cid:3)

 When applied to national control measures the main problem is related to the 
measurement of PH outcomes, especially when the collection of proper data was 
not previously planned.

 Intervention studies should ideally be carried out in pilot areas before the 
extension to broader scale (pre-test).

 The results of “

unplanned” experiments need to be carefully analysed.  

Expert opinions
evidence and be updated as knowledge evolves.

. They are useful in particular for risk managers. Should be based on 

Specifi c techniques to “weight” the expert opinions exist and should be applied.

. It addresses pathways taking into account the level of 

Exposure assessment
contamination in potential sources. The approach has not been applied broadly and 
has limitations mainly due to the uncertainty of D-R relationship. At present it can be 
used to stimulate the generation of hypotheses.

 (cid:2)

 (cid:2)

 (cid:2)

160.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 4 

  Presentations of the Discussion Groups

3.  Consider data availability and propose additional data 

collection (special studies, surveillance) in humans and in the 
food chain needed for source attribution, taking into account 
diff  erences between Member States. 

 (cid:2)

Data available at 

food chain level:

 (cid:3)

 (cid:3)

 (cid:3)

 (cid:3)

 (cid:3)

2008 EU 

baseline study (for chicken only)

Prevalence data
 reported in the Community Zoonoses Report derive mainly 
from (multi)annual national plans. Limited quantitative data are available and 
data comparability is diffi  cult. They represent a useful background information, 
but their use in source attribution is limited.

 are available at some laboratories, but type of collection and related 

Isolates
variables are not always known

Production and sales data
should be explored. Possible problems for products having a local market.

 are available. The degree of accessibility of these data 

Import – export and intra-community trade data
and completeness.

. Limitations in accessibility 

 (cid:2)

Data available at 

human level:

 (cid:3) Reported cases in most Countries are available, often at aggregate level
 (cid:3) Isolates are available, but a systematic collection of samples is in place only in 

few countries.

 (cid:3)

 (cid:3)

 Data from 

case-control studies, outbreaks, etc. in some Countries

 Activities to gather 

food consumption data at EU level are ongoing (EFSA)

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

161.

 
 
 
 (cid:2)

Additional data collection at food chain and human level:

 (cid:3)

 (cid:3)

 (cid:3)

 (cid:3)

existing data sources, availability of which should be explored 

 Priorities to 
(general isolates and samples taken during case-control studies). 
An overview of the studies and data suited for source attribution might be 
of benefi t (ECDC – EFSA) 

 Through strengthening public health surveillance systems (case-based reporting 
of human data, travel history, storage of randomly collected samples)

 Strengthening surveillance and sampling designs to get comparable information 
on human disease and food contamination (particularly at retail to be used in 
exposure assessment approach). “Sentinel” sites may be selected around Europe.

 A consensus should be reached in EU on the methods for
typing for the future creation of a EU typing database

 Campylobacter sub-

4.  Identify possible approaches to establishing the degree 

of underreporting and discuss their applicability at national 
and EU level.

 (cid:2)

Diff erences between under-reporting and under-ascertainment. 
Possible approaches:

 (cid:3)

 (cid:3)

 (cid:3)

Estimation of under-ascertainment at each point in the surveillance pyramid 
(% persons going to doctor, % of stool samples, % false negative lab results, etc.). 

Targeted retrospective or prospective studies (by questionnaires, phone 
interview, etc.) to estimate the burden of diarrhoeal illness. More opportunities 
given by technologies (SMS, web, etc.) 

Sero-surveillance studies. The main critical aspect is the knowledge on 
disease/infection rate and the shape of this relationship. Host factors 
(immunity, medical history, genetic factors and interaction with strains) 
should be taken into consideration.

162.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Discussion Group 2

Quantitative risk assessment of Campylobacter 
in broiler meat in the EU

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

163.

1.  Consider the state-of-the-art of risk assessment of 

Campylobacter in the broiler meat chain. Discuss to what 
degree diff  erent models have come to the same conclusions 
or appear to be contradictory. Propose recommendations for 
further development of risk assessment models.

 (cid:2)

11 models

 (8 EU + 3 non-EU) identifi ed 

 (cid:3)

 similar conclusions in a qualitative way

A. 

 (in the meat) poses the largest risk (although at 

High concentration
consumption low levels are ingested):
high prevalence carcass contamination but low numbers would be preferred 
over low prevalence contamination and high numbers (although this is 
simplifi cation)

B. 

Cross-contamination is important but 
cross-contamination)

bias in model (set-up only looking at 

Need to consider further development of models

 -

consider for other type of poultry products
preparations because of other consumer behaviour undercooking should be 
considered

 e.g. minced meat and meat 

 -

take up expertise of social sciences to fi netune module 
on consumer behaviour – important module to link contamination 
in the food chain to the public health outcome

164.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 4 

  Presentations of the Discussion Groups

C. 

All the models consider the same 
a limited data set (extrapolation at low levels?) and not take up genomic 
variability of the strain (pathotype e.g. link to Guillain Barré syndrome)

dose-response model which is based upon 

Need to consider development of better dose-response models (although this 
is not an easy task)

 -

outbreak data ? 

 -

dose response curve for various Seq. Types
(important in chicken and in human cases) vs. ST u48 (important in chicken - 
but not in human cases) – FluorQ. Resistant strains?

 e.g. In New Zealand ST 474 

 -

What about multiple exposure – immunity due repeated challenge / multiple 
strains in mixed infections

Further developments in methodology of risk assessment

 -

 with ability to update the model estimates and to 

Bayesian modelling
include prior knowledge (to combine observation and expert opinion) – 
use as an integrated approach with Monte Carlo simulation (e.g. Apparant 
prevalence vs. True prevalence) to use all the information available

 -

Include 

variability on processing practices in models (if data are available)

 -

Should include/model 
assumptions made) but important in communication to risk managers

uncertainty (although it is diffi  cult especially if many 

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

165.

 
2.  Evaluate current available quantitative data on Campylobacter 
in the broiler meat chain as well as on the cross contamination 
between broiler meat and other foods. Identify critical data 
gaps to support risk assessment modelling and validation. 

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

Models are often refering to the same data sets that were derived from one specifi c 
situation in one specifi c country – need to be updated

More Q-data become available on cross-contamination – or distribution of numbers 
on meat e.g. Baseline survey

Quality of data – P/A and enumeration data

 (cid:3)

 (cid:3)

 (cid:3)

Take into account for input of model Measurement Uncertainty

Use the right method, also for sub-lethal injured cells (= can be resuscitated!), 
especially if evaluating interventions that stress cells (VBNC ? First proof that they 
are fi t = infective/competitive)

Need of Best practices on how to treat the quantitative data, to turn them into 
distributions, especially handling data below detection limit

List main types of fresh poultry meat and meat preparation in EU - needed to 
compare the risk derived from various types of poultry meat 

Need to know variability among member states but also among food business 
operators (slaughter and further processing) within a country among population 
(cultural diff erences)

 (cid:2)

Data gaps

 (cid:3)

 (cid:3)

 (cid:3)

 relation cecal/GI contamination and live birds exterior (feather/skin) 

e.g.
contamination : is it linear or depends upon the way you slaughter

e.g.

 frequency of cecal/GI leakage during evisceration

 Q-eff ect of technological interventions (and the way they are implemented = 

e.g.
variability!) e.g. air chilling, hygienic design of equipment

e (cid:3) .g. consumer behaviour – need of observational data for diff erent scenario’s 

(diff erent countries, diff erent eating habits and food preparation)

 (cid:3)

 (cid:3)

More Qdata on cross-contamination, also from naturally contaminated samples, 
also transfer rates from cutting boards to RTE (cooked) product (other adhesion 
properties of meat)

More Qdata on cross-contamination in production environment 

166.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 4 

  Presentations of the Discussion Groups

3.  Consider quantitative insights from current risk assessment 
models on the eff  ectiveness of interventions (such as the 
importance of reducing numbers rather than prevalence, 
the degree of eff  ectiveness of logistic slaughtering, etc.) and 
evaluate the availability of data to validate such models. 
Identify areas where model results are disputable or at odds 
with available data (e.g. the impact of partial depopulation) 
and ways forward to address these issues.

Validate= fi t for purpose ? 

 (cid:2)

If purpose is comparison of intervention measures

 (cid:3)

To validate if we have feasible/promising options: pilot studies in plant, fi eld trials 
to implement and obtain (reproducible) “real life data” to establish cost/benefi t 
and variability e.g. fl y screens – ultrasound-steam, consumer campaigns

 (cid:2)

Use of (repeated) baseline surveys but to validate ? Many (risk) factors interact – 
underlying changes/new trends in production practices and consumer behaviour 
which might intermingle and confuses the eff ect of intervention measures

 (cid:2)

If purpose is to estimate the risk to public health

 (cid:3)

 (cid:3)

 More diffi  cult – need to know contribution of particular product to burden of 
disease + rely on reporting system whereas for Campylobacter often sporadic 
cases not that much institutional food borne outbreaks and latter are probably 
biased in reporting

 Sometimes intervention measures are hard to evaluate by routine surveillance
e.g. in Sweden : should divert broilers from producers with high Campy levels 
only noticeable in reported cases if Swedish broiler meat causes at least 50% 
of reported human cases otherwise it will be within the baseline fl uctuations 
of reported cases. Maybe only see an eff ect if setting up targeted epi-studies 
(e.g. New Zealand)

 (cid:3)

 = looking at cost benefi t?  Will it really matter ?

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

167.

 
 
Disputable outcome on eff  ect of thinning
 (cid:2)

Rather disputable because insuffi  cient knowledge on the quantitative eff ect (e.g.
 is 
excretion really signifi cant in numbers of Campylobacter at time of slaughter, what 
about prevalence within the fl ock, what about infl uence of age on the numbers of 
Campylobacter excreted)

 (cid:2)

Disputable because diff erent practices in diff erent countries

Risk assessment = added value because
 (cid:2)

Integrates knowledge

 (cid:2)

 (cid:2)

 (cid:2)

Brings together data and mulitidisciplinary

Quantitative – scenario analysis

Estimate before you start off  and invest in further testing 
of intervention measures in fi eld trials

4.  Consider the applicability of current models to support decision 

making on control options at the European level. Assess in 
particular the eff  ectiveness of interventions across the EU so as 
to support the setting of targets and/or performance objectives. 

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

Food industry needs guidelines/target (at the end) of the production chain 

Models agree that reducing the numbers is most eff ective
(processing criterion?) such as only X% of birds (cecal samples) or fresh meat 
(carcass or neck skin or end of production line) can have not more than Y cfu/g or cm2 
(defi ned by the method) at a certain stage of the food chain

 e.g. target 

Even with the same target/PO you will have diff erent outcome per country on public 
health (human cases) depending upon the (evolution) of the consumer behaviour

Take opportunity of the Q-data from the baseline survey in each country to cut 
the tails of distribution – to start circle of improvement by setting targets for 
Food Safety Management Systems in poultry chain

168.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 4 

  Presentations of the Discussion Groups

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

Models available today are constructed at national level (not for the EU situation). 
Can we have a generic EU model ? Variability upon MS ! Need to do additional eff orts 
to set it up

We can use today the national models (conditional if you accept the assumptions 
it is based upon = valid on generic EU level ?) 

The models agree there is a correlation between concentration on the product 
at retail and the probability of illness

If you know the distribution in this particular product you can calculate the risk 
reduction

Do we have scientifi c arguments from the models to decide where in the food chain  
to put the target 

 (cid:3)

 (cid:3)

the closer to the consumer – the less variability and uncertainty 
but the less practical and room for corrective action . 

If at the beginning in the food chain then easier to take measures 
but the correlation is less because you have more variability in the chain.

Risk assessment approach versus pragmatic approach
as Salmonella in poultry chain to begin with 

 e.g. start off  with same targets 

Have to think global 

Target within EU should be the same for non-EU countries 

International companies need same rules

Should link to level of protection – need ALOP to be defi ned by risk managers  

Setting targets/PO is associated with risk reduction, not with zero tolerance

Quantitative data throughout the production chain and throughout Europe will help 
to fi netune the models for risk assessment and provide more accurate estimates and 
help to establish quantitative targets

 (cid:3)

 (cid:3)

Enumeration of

 Campylobacter with robust methods (microbiological data) 

Consumer behaviour (relationship to food handling and eating habits)

 (cid:2)

The next challenge will be to integrate variability throughout Europe and develop a 
generic model 

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

169.

 
170.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Discussion Group 3

Fluoroquinolone resistance in Campylobacter

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

171.

1.  Consider the prevalence of FQ-resistance in poultry fl ocks, 
on carcasses and on poultry meat and its relationship to 
antimicrobial usage in animal production.

 (cid:2)

 (cid:2)

Some  country reports on FQ resistance prevalences (poultry, poultry meat, humans), 
see EFSA zoonoses report

Monitoring of both resistance and drug use at the national level is essential 

 (cid:3)

 (cid:3)

 (cid:3)

 (cid:3)

Follow trends, basis for risk assessment, guide interventions, monitor eff ects of 
interventions

Several countries have national drug use monitoring

In many other countries drug use data are present, but not easily accessable

The systems diff er considerable between countries (e.g.
prescriptions, sales at species level, or just total sale).

 based upon 

 (cid:2)

There are scientifi c evidence that the use of FQ have lead to emergence of FQ-
resistance in Campylobacter in poultry fl ocks. 

 (cid:3)

 (cid:3)

The exact nature of the relationship is not known

Not known whether strategic use (e.g.
lead to less emergence of resistance. 

 only within the fi rst week of life) would 

Whether there are diff erences between the diff erent quinolones in the selective 
ability is unknown.

There is a correlation between resistance levels in broilers, carcasses and on meat 

 (cid:3)

The latter is more diffi  cult to determine because of the eff ect of cross-
contamination and also because meat at retail also come from other sources.

 (cid:2)

 (cid:2)

 (cid:2)

The eff ect of withdrawal of FQ is not well understood 

 (cid:3)

 (cid:3)

 (cid:3)

Major interventions (e.g.
to be necessary to obtain a signifi cant eff ect

 ban, stringent compliance) on drug usage are expected 

A full stop of FQ use will probably halt further increase in resistance, but not 
necessarily mean that resistance will decrease. 

Eff ects of interventions should be assessed (e.g.
growth promoters)

 missed opportunities with the 

172.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 4 

  Presentations of the Discussion Groups

2.  Evaluate the signifi cance of FQ-resistant Campylobacter 

on broiler meat from a public health perspective. 
Consider the available evidence and risk assessment models 
to quantify the proportion of FQ-resistant human cases 
attributable to broiler meat.

Signifi cant or added risk of FQ?

 (cid:2)

Diff erent studies/reviews/analyses have reached diff erent conclusions whether FQ 
resistant strains are more hazardous in regard to 

 (cid:3)

 (cid:3)

 (cid:3)

Prolonged symptoms (diarrhoea)

Severity 

Hospitalization rate

 (cid:2)

 (cid:2)

Studies in DK and US have found increased risks (ref), UK studies and a study of 
Wassenaar not (ref)

Diff erent risks for diff erent patient populations:

 (cid:3)

 (cid:3)

Not severe cases do not require antimicrobial therapy anyway

Severe cases of diarrea of uknown origin are normally treated empirically with 
antimicrobials (generally a FQ if suspicion of e.g. Salmonella) and if FQ resistant 
organisms, including Campylobacter, are present there is increased risk of 
treatment failure and adverse outcome 

 (cid:2)

Recent indications of increased infection rates of FQ resistant
in humans that are receiving FQ treatment (ref. Molbak)

 Campylobacter strains 

%Human Camp cases attributable to broiler meat (1)

 (cid:2)

 (cid:2)

A majority of
likely the same with infections with FQ resistant Campylobacter

 Campylobacter infection cases are acquired from broiler meat. Most 

Other sources for
be taken into consideration

 Campylobacter, incl FQ resistant strains, than broiler meat, should 

 (cid:3)

Environment and water: indirect contamination from animals (including broilers) 
and possibly humans

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

173.

 
%Human cases of FQ res Camp attributable to broiler meat (2a)

 (cid:2)

Need for more studies to assess risk factors for FQ resistant

 Campylobacter infection 

E (cid:3) .g. longitudinal studies in human volunteers (travel, type of foods – broiler meat, 

imported foods, patient previous antimicrobial exposure, etc.), including 
susceptibility profi le and typing of the isolates, with regular samples from 
environmental sources & samples from locally-produced and imported food 
from the same period. 

 (cid:3)

Should not focus only on broiler meat, but all poultry meat (e.g.
exposure in turkey production)

 higher antibiotic 

3.  Consider the possibilities for and impact of reducing 

antimicrobial usage in broiler production on the occurrence 
of resistant Campylobacter on broiler meat and the public 
health impact of such control.

Public health impact of reducing FQ

 (cid:2)

 (cid:2)

 (cid:2)

FQ resistance is increasing in Camp from humans and poultry

Studies from many countries: Resistance in humans follows the usage of FQ 
in food animals and build up of resistance among Campylobacter in food animals

Danish and Norwegian study, % resistant Camp among domestic poultry 
(low usage of FQ in poultry) and domestically aquired cases low, while travel related 
cases is very high

174.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 4 

  Presentations of the Discussion Groups

Possibilities of reducing in FQ

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

Prescription is a requirement in the EU and this should be extended 
to the rest of the world

 (cid:3)

Compliance / illegal use?

Some countries have shown that it is possible to produce poultry 
with limited or without FQ use

 (cid:3)

 (cid:3)

 (cid:3)

Australia and NZ

Nordic countries

US banned FQ in poultry in 2006 

Lack of knowledge of what will be the impact on diff erent management options 
(ban, only for certain indications, off -label use, only after susceptibility testing etc.)

Carry-over of small quantities of FQ in the poultry environment (FQ used in water)

FQ slowly degraded in the environment

4.  Identify critical data gaps and recommend further studies to 

address these data gaps

 (cid:2)

Need  for monitoring of drug usage of antimicrobial agents

 (cid:3)

 (cid:3)

 (cid:3)

 (cid:3)

Progress in some countries

Monitoring needs to be harmonised for comparability between countries.

A work-shop on best and feasible practices for monitoring drug usage should be 
held, to recommend a common system for all EU-member countries. 

A EU database on drug usage in food animals should be established.

 (cid:2)

 (cid:2)

The exact relationship between drug use and resistance needs to be further studied

Experience from diff erent countries, incl US and Australia needs to be further studied

 (cid:3)

 (cid:3)

Public health impact?

Eff ects on poultry industry incl animal health?

 (cid:2)

Impact on import of FQ res Camp through food from third countries?

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

175.

 
 (cid:2)

 (cid:2)

Careful re-analysis of previous work regarding public health risks of FQ resistant 
strains versus FQ susceptible strains

Need for more studies to assess risk factors for FQ resistant

 Campylobacter infection 

 (cid:3)

g. longitudinal studies in human volunteers (travel, type of foods – broiler meat, 

E.
imported foods, patient previous antimicrobial exposure, etc.), including 
susceptibility profi le and typing of the isolates, with regular samples from 
environmental sources & samples from locally-produced and imported food from 
the same period. 

 (cid:3)

Should not focus only on broiler meat, but all poultry meat (e.g.
exposure in turkey production)

 higher antibiotic 

 (cid:2)

Lack of knowledge regarding whether FQ resistant isolates belong to specifi c clones 
and/or have particular properties (e.g. increased fi tness, virulence?)

Conclusions

 (cid:2)

 (cid:2)

There is scientifi c evidence that the use of FQ in poultry has lead to emergence of 
FQ-resistance in Campylobacter in poultry and has further spread to humans

There is a public health benefi t from reducing FQ use in food animals 

 (cid:3)

Not yet able to quantify the eff ect in case of

 Campylobacter 

 -

Diff erent studies/reviews/analyses have reached diff erent conclusions 
whether FQ resistant strains are more hazardous than FQ susceptible strains

 (cid:3)

 (cid:3)

Severe cases of diarrea of uknown origin are normally treated empirically with 
antimicrobials and if FQ resistant organisms are present there is increased risk of 
treatment failure and adverse outcome 

Recent indications of increased infection rates of FQ resistant
strains in humans that are receiving FQ treatment

 Campylobacter 

 (cid:2)

It is possible to produce poultry with limited or without FQ use, but need more data on

 (cid:3)

 (cid:3)

Public health benefi t?

Impact on the poultry industry incl animal health?

 (cid:2)

 (cid:2)

FQ is a critical important drug in humans and should therefore be a drug of last 
resort for therapeutic use in food animals

Prudent antimicrobial use policy should be promoted and adhered to

176.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Discussion Group 4

Assessment of eff ectiveness of control measures 
in the food chain

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

177.

Additional remarks

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

 (cid:2)

Economic changes: cheaper products (e.g.

 import)

Approach for free-range: compromise between welfare and safe product

What is eff ectiveness: abscence/reduction? Few human cases

Inform consumers that all foods including poultry meat carry risks

Strain specifi c issues

Incentives for farmers?

1.  From the European perspective, consider the eff  ectiveness 
of current and proposed pre- and at-harvest controls for 
Campylobacter in broiler chicken fl ocks and propose further 
studies to develop more eff  ective controls. State the strong and 
weak points of the control measures identifi ed, considering 
explicitly the perspective of industry and consumers, and 
identify possible barriers to their introduction.

2.  List and rank the possible post-harvest controls in terms 

of eff  ectiveness from a European perspective. 

3.  Consider the evidence on the eff  ectiveness of producer, 

processor and consumer education to reduce the risk of human 
campylobacteriosis. Consider the need for new studies aimed 
at the identifi cation, collection and evaluation of new data on 
the eff  ectiveness of education and awareness programmes.

178.

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

Annex 4 

  Presentations of the Discussion Groups

 (cid:2)

Eff ect of education:

1. 

Producer: short lived, incentive related

2. 

Processor: short lived, HACCP compliance

3. 

Consumer: short lived, they don’t listen; school children

4.  Consider at which points along the food chain, monitoring, 

targets, microbiological criteria, and/or performance objectives 
would be most eff  ective and recommend how best this would 
be implemented.

1. 

where implementation of intervention strategies?

2. 

Monitor (continuous) eff ect of strategies 

3. 

Options:

1. 

Ideally on-farm (scheduling)

2. 

Caeca (yes/no) as in baseline study

3. 

End of slaughterline (quantitative?)

4. 

Retail?

Key issues

 (cid:2)

 (cid:2)

Fully integrated farm to consumer approach

Focus on highly contaminated carcasses

Summary Report EFSA Scientifi c Colloquium 12, 4-5 December 2008, Rome, Italy

179.

 
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ASSESSING 
HEALTH BENEFITS 
OF CONTROLLING 
CAMPYLOBACTER 
IN THE FOOD CHAIN

Largo N. Palli 5/A 
I-43121 Parma 
Italy
Tel: +39 0521 036 111
Fax: +39 0521 036 110
www.efsa.europa.eu

4-5 December 2008, Rome, Italy