JMIR Publications

ABSTRACT

Background:

Food safety is a global concern, often underestimated due to challenges in investigating foodborne diseases. These challenges arise from the increased globalization of food trade, advancements in agricultural practices, and shifts in environmental factors. In North-eastern India, common diarrheal outbreaks from fermented foods pose significant health risks. Despite these challenges, systematic data on foodborne pathogens is lacking in India, highlighting a crucial gap in understanding food safety issues.

Objective:

The aim of this research protocol is to establish an integrated surveillance system for enteric pathogens amongst humans, food, animals, and the environment in North-East India, and to conduct outbreak investigations.

Methods:

The Indian Council of Medical Research (ICMR) initiated a surveillance study across all eight North-East states, employing a centralized digital database for data collation. The project aims to enhance infrastructure for microbial culture, antibiotic sensitivity testing, and molecular epidemiological studies. The study involves laboratory-based surveillance of foodborne pathogens in market foods, hospitalized diarrheal patients, poultry and animal farms, slaughterhouses, butcher shops, and diarrheal outbreaks. A standardized case report form ensures consistent data collection on age, sex, signs, symptoms, and admission dates for diarrheal cases. Stool and rectal swabs undergo testing for pathogen identification and antimicrobial resistance (AMR). Similarly, samples of market foods, food animals, and the environment are collected. Outbreaks confirmed by the Integrated Disease Surveillance Project (IDSP) are thoroughly investigated following standardized guidelines.

Results:

In the Phase I, five surveillance centers were established across four states, i.e., Assam (Dibrugarh & Guwahati), Tripura, Sikkim and Arunachal Pradesh in 2020. Following an interim Phase I data assessment and the successful establishment of a streamlined system for data procurement, investigation, recording, and analysis, along with the implementation of regular training and monitoring programs, the Phase II expansion was initiated during 2023-24. This includes the addition of seven more centers (including 3 veterinary centers) in the remaining four states, i.e. Manipur, Meghalaya, Mizoram and Nagaland, eventually covering the entire North-Eastern Region (NER) of India.

Conclusions:

Food and waterborne diseases are a constant public health problem in many countries. Key challenges of the enhancement of food safety policy are the paucity of systematic data and awareness. With this background, ICMR’s initiative is the first systematic surveillance study in the country to adopt one health approach. Data obtained from this project will help to understand the risk of acquiring food and waterborne pathogens, their transmission pathways and antimicrobial resistance patterns. The scientific evidence generated through this project will be helpful in formulating and strengthening food safety policy and to initiate Government programs to protect the health of the nation.