C-EnterNet News Volume 1, 2006

C-EnterNet: Overview Source Attribution Enteric disease: a major health concern in Canada The case for comprehensive surveillance The necessity of sentinel sites Sustainable funding requirements Looking ahead C-EnterNet team Contact us

Overview

C-EnterNet (pronounced centre-net): Reducing the burden of gastrointestinal disease in Canada

The Public Health Agency of Canada's mission is to promote and protect the health of Canadians through leadership, partnership, innovation and action in public health. Surveillance - the systematic process of collecting, analyzing, interpreting and communicating health-related data to reduce disease rates and mortality - is one of the key components of public health practice. It complements other public health activities aimed at preventing outbreaks and sporadic cases of infectious diseases.

Individual surveillance programs have various public health goals and policy objectives. In recent years, the scope of, and our reliance on, surveillance programs have grown significantly in all parts of the world because of globalization and threats of multi-resistant bacteria (“superbugs”), bioterrorism and pandemics. Many surveillance programs focus on the dynamic pathogens that cause infectious enteric disease in humans. In Canada, steps have been taken to successfully eliminate some of these pathogens, including endemic typhoid fever and cholera, and to significantly reduce the presence of others, including Shigella, in the human population.

However, infectious enteric disease remains a major health concern in Canada.

C-EnterNet is a multi-partner initiative facilitated by the Public Health Agency of Canada. It is meant to support activities that will reduce the burden of enteric disease, by comprehensive sentinel site surveillance implemented through local public health units. This initiative will result in effective evaluation and development of policies related to the safety of food and water. Its approach is in line with leading-edge work in public health, as called for in Canada by the recent Haines (meat safety), Naylor (SARS outbreak) and O'Connor (water safety) reports, the Auditor General and the Pan-Canadian Public Health Network; in the United States, by the Centers for Disease Control and Prevention (CDC); in Australia, by the Department of Health and Ageing; and in the European Union, by the Integrated Approach to Food Safety. Such work focuses on the necessity of collaboration among jurisdictions and of integration of efforts, new communication networks, rigorous systematization, and involvement of local public health units to inform policy at the local, regional and national levels.

The C-EnterNet surveillance framework includes :

• strengthening of the public health infrastructure;
• more effective collaboration among all levels of public health organizations and with participating communities; and
• taking disease surveillance to a higher level, with better source attribution methodology allowing for more reliable assessment of risks posed by enteric pathogens to Canadian communities.

The C-EnterNet model

The C-EnterNet model is based on the Centers for Disease Control and Prevention (CDC) FoodNet sentinel site model - a leading-edge surveillance approach implemented to reduce the occurrence and impact of foodborne diseases in the United States . However, C-EnterNet's scientific mandate is broader; it includes simultaneous and in-depth investigation of foodborne and waterborne diseases and exposure. In-depth, community-based investigation is done through sentinel site surveillance. The selection of sentinel site locations is based on specific criteria. Such criteria ensure that cost efficiencies are achieved for sample collection and laboratory analysis, and that data results may be generalized for communities across Canada . Each sentinel site is established in a unique partnership with local public health units that includes a working network with the local water, agriculture and retail food sectors, as well as the provincial and federal institutions responsible for public health.

In addition to the Region of Waterloo pilot site, C-EnterNet envisions a network including at least four other sentinel sites in Canada.