WHO | Ensuring food safety in the aftermath of = natural disasters

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Last Updated
10 January 2005

Ensuring = food safety in=20 the aftermath of natural disasters

Introduction

Following = natural=20 disasters, such as the recent earthquake and tsunami in South East Asia, = food in=20 affected areas may become contaminated and consequently be at risk for = outbreaks=20 of foodborne disease, including diarrhoea, dysentery, cholera, hepatitis = A, and=20 typhoid fever. Poor sanitation, including lack of safe water and toilet=20 facilities and lack of suitable conditions to prepare food have led to = mass=20 outbreaks of foodborne disease. As persons suffering from the direct = effects the=20 disaster may already be at risk through malnutrition, exposure, shock = and other=20 traumas, it becomes essential that the food they consume is safe. This = is=20 particularly important for foods for infants, pregnant women and the = elderly who=20 are most susceptible to foodborne disease. Under most conditions, the = threats=20 posed by contaminated water and food are interrelated and cannot be = separated.=20 Therefore, water should be treated as a contaminated food and should be = boiled=20 or otherwise made safe before it is consumed or used as an ingredient in = food.=20 WHO has prepared guidance for public health and other authorities on the = key the=20 food safety issues to be considered in disaster situations. This = includes a=20 reminder that authorities must maintain existing support for food safety = and=20 heighten their vigilance against new foodborne risks introduced by the = disaster.=20 Basic messages, such as those contained in the WHO Five Keys for Safer = Food,=20 should be reinforced to all food handlers, especially those involved in = mass=20 catering.

This guide is intended to:

provide public health and other authorities with guidance on key = food=20 safety issues to be considered in such disaster situations;=20
remind authorities of the need to restore and maintain basic = support for=20 food safety infrastructure;=20
heighten their vigilance against the introduction of new foodborne = risks;=20
serve as a quick reference to those involved in providing = emergency food=20 aid, such as refugee camp managers and food distributions; and=20
provide guidance for the development of simple messages to anyone, = including ordinary consumers, involved in food preparation in disaster = areas.=20

While = contamination can=20 always occur at all points of the food-chain, inadequate washing, = handling and=20 cooking of food just before consumption is still a prime cause of = foodborne=20 disease. Many disease cases are preventable by observing simple hygienic = rules=20 during food preparation whether in family settings or in large food = catering=20 facilities. Therefore this guide offers specific advice to those = involved in=20 food preparation during disaster situations which is modelled after the = standard=20 WHO Five Keys to Safer Food (http://www.who.int/foodsafety/consumer/5keys/en/)

1. = Preventive food=20 safety measures in the aftermath of natural disasters

During and = following=20 natural disasters, particularly floods and tsunamis, food may become=20 contaminated by surface water that has itself been contaminated by=20 pathogenic bacteria from sewage and wastewaters from sewer systems, = septic=20 tanks, and latrines as well as from farms and farm animal. The following = issues=20 should be investigated:

The protection of food requires attention along the food-chain, = including=20 the primary production sectors.=20
While much of the normal agricultural production may be adversely = affected=20 by flooding associated with a tsunami, there may be areas where food = can still=20 be harvested or where food has been stored safely post harvesting.=20
If agricultural produce is harvested from an area affected with = flooding=20 it may be contaminated with microorganisms (from raw sewage or = decaying=20 organisms) and chemicals in the flood waters. While it is possible to = reduce=20 the potential hazard associated microorganisms by thoroughly cooking = the=20 produce, such actions may not remove chemical hazards. Therefore only = harvest=20 food from affected areas where it is necessary and where you can be = confident=20 that chemical contamination has not occurred. Also ensure the product = is=20 properly identified as being harvested from an affected area.=20
Similarly agricultural produce that was stored in the affected = areas at=20 the time of the disaster may also be affected by the flood waters. = Such food=20 should be treated as with food harvested from affected areas.=20
If crop fields have been contaminated by human excreta, following = floods=20 or damage to sewerage systems, an assessment should be carried out = rapidly to=20 assess the contamination of crops and to establish measures, such as = delayed=20 harvesting and thorough washing and cooking, to reduce the risk of=20 transmitting faecal pathogens.=20
Foods that have not been affected should be protected against = exposure to=20 other sources of contamination and not kept under conditions in which=20 bacterial growth may occur.

Safe and hygienic warehouse management must be=20 observed:

Storage structures should have good roofs and ventilation. = Products should=20 be kept at away from walls and off the floor. Pallets, boards, heavy = branches,=20 bricks, or plastic bags or sheets should be placed underneath them. = Bags=20 should be piled two-by-two cross-wise to permit ventilation.=20
Spilled food should be swept up and disposed of promptly to = discourage=20 rats.=20
Fuel, pesticides, bleach and other chemical stocks should never be = stored=20 together with food.=20
If spray operations for pest control are needed, they should be = carried=20 out by qualified technical staff, under the close supervision of the = national=20 authority (Ministry of Health / Ministry of Agriculture). Wearing of=20 protective gear to reduce exposure of the operators to toxic chemicals = is=20 essential.

Safe food handling during food distribution and = preparation=20 must be assured

During = emergency=20 response operations, large-scale distribution of imported or=20 locally-purchased food items as well as mass preparation of cooked food=20 frequently occur. In this context special attention must be brought to = the=20 following:

All foods used in food distribution and mass feeding = programmes must=20 be fit for human consumption (as well as being nutritionally = and=20 culturally appropriate) The quality and safety of all items should be=20 controlled before importation or local purchase and any unfit items be = rejected.=20
Stocks should be regularly inspected and any suspect stocks should = be=20 separated from other stocks and samples be sent to a suitable = laboratory for=20 analysis; in the meantime they should not be used.=20
Kitchen supervisors, cooks and ancillary personnel should be = trained in=20 personal hygiene and the principles of safe food preparation (See = Annex).=20
Kitchen supervisors should be trained to be able to recognize = potential=20 hazards and apply appropriate food safety measures; the personal = hygiene of=20 personnel involved in food preparation should be monitored.=20
Employees and volunteers preparing food should not be suffering = from an=20 illness with any of the following symptoms: jaundice, diarrhoea, = vomiting,=20 fever, sore throat (with fever), visibly infected skin lesions (boils, = cuts,=20 etc.), or discharge from the ears, eyes or nose.=20
Cleaners should be employed to keep the kitchen and surrounding = areas=20 clean; they should be properly trained and their work supervised and = there=20 must be adequate facilities for waste disposal.=20
Water and soap must be provided for personal cleanliness, and = detergent=20 for cleaning utensils and surfaces which should also be sanitized with = boiling=20 water or a sanitizing agent, e.g. bleach solution.=20
Foods should be stored in containers that will prevent = contamination by=20 rodents, insects, or other animals=20
Hot and/or cold holding of food may have to be improvised. =

2. Consumer = education=20 and information

In many cases, consumers will be preparing food under conditions = that are=20 more primitive than normal, due to lack of water supply and = electricity. This=20 is especially the case for homeless people who have no facilities or = equipment=20 for food preparation. In all cases however, consumers should be warned = to take=20 special care regarding food safety from the procurement of raw = materials and=20 water, through handling and preparation to final consumption. In this = regard,=20 WHO's Five Keys to Safer Food have been adapted to be more relevant to = the=20 current tsunami disaster conditions in South East Asia. This version = is=20 presented in the Annex. This version could provide guidance for the=20 preparation of local versions aimed at specific target populations. It = is also=20 recognized that this version may need other adaptations to meet the = needs of=20 the local situation. For example, when food is likely to be = contaminated by=20 chemicals from warehouses, chemical plants, and other sources, people = should=20 be advised to avoid those types of food.

General = information and=20 advice should also be provided to the population on the risks of = foodborne=20 diseases to remind the population that:

dangerous communicable disease outbreaks in disaster regions has = the=20 potential to claim as many lives as the disaster itself, and that safe = water=20 and food are the two main factors to prevent such outbreaks.=20
key behaviours of safe food handling and preparation are the most=20 important measures they can take to protect their families and = themselves=20
key behaviours of hygiene and sanitation are the most important = measures=20 they can take to protect the society from disease outbreaks. =

3. = Inspecting and=20 salvaging food

Food industries, slaughterhouses, markets and catering = establishments=20 should be inspected to ensure their safe operation. Particularly = attention=20 should be given to those handling perishable products, such as milk. = Steps=20 should be taken so that foods that have been adversely affected are = not=20 marketed.=20
When salvaged foods are fit for consumption and sold, they should = be=20 labelled accordingly and consumers should be clearly informed of = measures they=20 need to take to render them safe.=20
In areas that have been flooded, whatever intact foods remain = should be=20 moved to a dry place, preferably away from the walls and off the = floor.=20
Any food stocks found to be unfit for human consumption must be = disposed=20 of -- used for animal feed, industrial purposes or destroyed depending = on the=20 assessment of food safety authorities. Condemned food may be marked = with a=20 harmless dye, such as gentian violet to ensure that the item will not = be used=20 for human consumption;=20
When salvaged foods are deemed fit for consumption and sold, they = should=20 be labelled accordingly. If necessary, consumers should be clearly = informed of=20 measures they need to take to render them safe.

Assessing and using salvaged pre-packaged food =

Discard canned foods with broken seams, dents, or leaks; and jars = with=20 cracks.=20
Undamaged canned goods and commercial glass jars of food are = likely to be=20 safe. However, if possible you should sanitize the containers before = opening=20 them for use. To do this, wash the jars and cans thoroughly. This may = result=20 in loss of labels so mark contents on can or jar lid with indelible = ink before=20 washing. Finally, immerse containers for 15 minutes in a solution of 2 = teaspoons of chlorine bleach per quart of room temperature water. Air = dry=20 before opening. Foods that are exposed to chemicals should be thrown = away. The=20 chemicals generally cannot be washed off the food. This includes foods = stored=20 in permeable containers like cardboard as well as screw-top jars and = bottles=20 which are difficult to clean.

Assessing and using salvaged refrigerated = food

Inspect refrigerators to determine if they have been affected by = the lack=20 of electricity or flood waters. Where refrigerators and cold food have = not=20 been directly affected, they may be a suitable source of safe food.=20
Where power is not available, try to use refrigerated food before = it is=20 held in the danger zone (5-60oC) for more than two hours, especially = meat,=20 fish, poultry and milk.=20
To avoid the loss of meat, fish, poultry and milk, these may be = placed in=20 a freezer immediately if they have not reached the danger zone. They = may also=20 be cooked and frozen if they are to be kept longer.=20
Some foods normally stored in the refrigerator can be kept in the = danger=20 zone for longer than others. Under emergency conditions it is possible = that=20 foods such as butter, margarine, fresh fruits and vegetables, open = jars of=20 concentrates and sauces and hard and processed cheeses can be kept and = used=20 for a longer period but they should definitely be discarded if they = show signs=20 of spoilage (odour, texture, gassiness, mouldiness).=20
To prevent warm air from entering the refrigerator, open it only = when=20 necessary.

Assessing and using salvaged dry stores of = food

Check all food for physical hazards (such as glass) that may have = been=20 introduced during the earthquake.=20
The likelihood of mould growth on stored dried vegetables, fruits = and=20 cereals is greater in a humid environment and where food has become = wet. Mould=20 growth can be associated with chemical toxins.=20
Intact food should be moved to a dry place, away from the walls = and off=20 the floor! Bags must not lie directly on the floor =E2=80=93 pallets, = boards, heavy=20 branches, bricks, or plastic bags or sheets should be placed = underneath them.=20 Bags should be piled two-by-two cross-wise to permit ventilation.=20
Wet bags should be allowed to dry in the sun before storing them.=20
Damaged bags should be rebagged and stored apart from undamaged = ones. A=20 reserve of good-quality empty bags should be kept for this purpose.=20
Spilled food should be swept up and disposed of promptly to = discourage=20 rats.

4. Provision = of food=20 after a natural disaster

After a natural disaster, as soon as families have reestablished = their=20 capacity to cook, any food they may be given is usually distributed in = dry=20 form for them to prepare and consume in their homes or temporary = shelters.=20 People may not always be familiar with all kinds of dry foods. When = given,=20 they should be shown how to prepare dry foods.=20
In addition to safe water for food preparation, a means of washing = hands=20 and utensils will be needed.=20
A shortage of fuel for cooking may also be a major constraint, and = this=20 may need to be supplied to ensure adequate cooking and reheating of = cooked=20 food.=20
In some cases, as an alternative to mass feeding, it may be = possible to=20 help households by providing shelf-stable rations that do not need = cooking or=20 by setting up temporary shared neighborhood kitchens where people can = prepare=20 food for their own families or in groups.

5. Response = to an=20 outbreak of foodborne disease

It is = vital to detect=20 foodborne diseases as early as possible. Indications of a foodborne = disease=20 outbreak that should trigger an investigation = include:

increase in diseased persons visiting clinics=20
reports from health workers of foodborne disease symptoms,=20
reports from pharmacists of an unusual demand for anti-diarrhoeal = agents,=20 anti-emetics or other medication for gastrointestinal problems, e.g.=20 antibiotics=20
an upsurge in inexplicable customers=E2=80=99 complaints to a food = supplier, food=20 industry=20
reports of unusual death=20
unusual absenteeism from schools and the workplace, especially in = large=20 industries

Detection may = also be=20 through existing communicable disease surveillance systems if the = cluster is=20 large enough (and there is no separate foodborne disease surveillance=20 system).

Investigation of and response to a suspected food = safety=20 emergency involves:

timely treatment of exposed people=20
removal (recall) of the contaminated food from circulation. This = should be=20 coordinated by the national food safety agency in collaboration with = the food=20 industry and other food providers.=20
rapid identification of the causative agent and the suspected = foods by=20 patient interviews and by appropriate diagnostic laboratory testing=20
epidemiological investigation to identify the causative agent, the = responsible food and the manner of contamination including: = collection,=20 transport and processing of samples; collation of information about = sources of=20 contamination and coordination with law enforcement, food safety = regulatory=20 authorities, industry, emergency medical response agencies, and (when = imported=20 food may be involved) quarantine and customs agencies (swift = communication=20 among all these entities is essential)=20
timely provision of information to the public on food-related = risks and=20 the actions they should take to minimize those risks; the information = must be=20 conveyed in a manner that is culturally appropriate and does not cause = unnecessary anxiety

The = effectiveness of=20 response depends to a great extent on preparedness including:

the capacities for investigation and verification, and=20
coordination between relevant government and other agencies that=20 contribute to managing the public health consequences.

Annex: "5 = Keys for Safer=20 Food - in regions hit by disasters"

The = information provided=20 is intended to present the five core food safety messages as they could = be=20 presented to people involved in food preparation in areas affected by = the=20 Tsunami disaster 26 December 2004. While it should be realized that some = of the=20 instructions mentioned here will not be practicable in all situations, = attempts=20 to adhere as best possible to the general keys will contribute to = disease=20 prevention. The general 5 keys, including translation into local = languages can=20 be found at http://www.who.int/foodsafety/publications/consumer/5keys=20

3D""

Food safety is essential for disease prevention =
In the=20 aftermath of natural disasters

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