Overview

C-EnterNet: Reducing the burden of gastrointestinal disease in Canada

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-drug resistant bacteria, 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.

What is infectious enteric disease?

Infectious enteric disease refers to gastrointestinal illnesses that result from ingesting bacteria, viruses or other parasitic micro-organisms that may be traced back to food, water, animals or an infected person. Some examples are Salmonella, E. coli, Listeria and Giardia. In humans, these micro-organisms can cause symptoms ranging from a few days of vomiting and/or diarrhea to severe chronic conditions or death.

C-EnterNet (pronounced centre net) is a multi-partner initiative facilitated by the Public Health Agency of Canada. It supports activities that will reduce the burden of enteric disease through comprehensive sentinel site surveillance implemented through local public health units. This initiative will result in effective evaluation and development of policies on the safety of food and water. Its approach is in line with recommendations included in several national reports and with similar international initiatives taken by the following:

• the Pan-Canadian Public Health Network
• the U.S. Centers for Disease Control and Prevention
• Australia’s Department of Health and Ageing (OzFoodNet)
• the New Zealand Food Safety Authority
• the European Union’s Integrated Approach to Food Safety

C-EnterNet’s 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

The C-EnterNet surveillance framework supports the following:

• strengthening the public health infrastructure;
• more effective collaboration among all levels of public health organizations and with participating communities; and
• improving disease surveillance by using better source attribution methodology, which provides 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 U.S. Centers for Disease Control and Prevention (CDC) FoodNet sentinel site model—a leading-edge surveillance approach implemented to reduce the occurrence and impact of food-borne diseases in the United States. However, C-EnterNet's scientific mandate is broader; it includes simultaneous and in-depth investigation of food-borne 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 can be generalized for communities across Canada. Sentinel sites are established in unique partnerships with local public health units that include a working network with the local water, agriculture and retail food sectors, as well as the provincial and federal institutions responsible for public health. Currently, there are two sentinel sites within the program: in Ontario (Region of Waterloo Public Health) and British Columbia (Fraser Health Authority).