The first sets of food safety risk communication and country-specific action plans to tackle the significant public health problem of foodborne parasites have been identified in Asia.

They were discussed at a regional meeting to accelerate prevention and control of neglected foodborne parasitic zoonoses in certain Asian countries in 2018 with a focus on foodborne trematode (FBT) infection, taeniasis and cysticercosis which is infection with the tapeworm Taenia solium and echinococcosis caused by Echinococcus.

It was organized by the Food and Agriculture Organization of the United Nations (FAO), the World Health Organization (WHO) and the World Organization for Animal Health (OIE), according to a recently published report. Participants agreed to develop a roadmap to help prevent and control neglected foodborne parasitic zoonoses. The WHO, FAO and OIE were requested to create a network to help countries share experiences.

The meeting in Lao People’s Democratic Republic included a trip to a pig slaughterhouse, fish and meat market, and a community wher pigs were raised at household level. Mitigation actions to avoid disease transmission include separation of produce, meat and fish in the local market, slaughterhouse employees being trained on how to identify and properly handle and dispose of endemic parasites and proper disposal and disinfection of solid and liquid waste in community pig pens and slaughterhouses.

Attendees heard it was essential to have stronger coordination between public and animal health, food, agriculture, and water, sanitation and hygiene (WASH) sectors to advance food production, processing and hygiene practices, to treat or vaccinate animals, and to improve sanitation to prevent contamination of the environment and infection of animal reservoirs to control diseases.

Transmission was linked to practices of raising livestock and producing, processing and preparing foods. The diseases were also zoonotic infections involving domestic or wild animals. Transmission continues because of poor hygiene and sanitation along the food chain from farm to table.

Situation in Bhutan, Cambodia and China
Participating countries presented their foodborne parasitic zoonosis status. Bhutan has a One Health Strategic Plan from 2017 to 2021. It has a passive surveillance system that only tracks reports of intestinal worms. The country had about 30,000 cases of intestinal worms between 2013 and 2017.

It is estimated that 10.1 percent of Cambodia is endemic with Opisthorchis viverrini. The country is also endemic with taeniasis/cysticercosis due to Taenia solium, but countrywide data are lacking. At the time of the meeting, there was no case reporting or notification systems to track these patients.

China is endemic with certain foodborne parasitic zoonoses but has a national program to prevent and control echinococcosis and other parasitic diseases from 2016 to 2020. The objective was to establish a surveillance system for key parasitic infections and reduce the infection rate of Clonorchis sinensis and other diseases by 2020.

Lao People’s Democratic Republic has a policy from 2018 to 2022 to control opisthorchiasis and taeniasis/cysticercosis including promoting health education for behavior changes; improving water, sanitation and toilets, and providing diagnosis and treatment.

Outlook for India, Thailand and Vietnam
The burden of foodborne diseases in India is not known because of underreporting, according to officials. The most common foodborne parasitic zoonoses affecting humans are taeniasis/cysticercosis and hydatidosis. There are high transmission rates of parasitic zoonoses in the country due to unhygienic living conditions, poverty and lack of education.

In Indonesia there was no surveillance system for foodborne parasitic diseases. At the time of the meeting, only one of 41 veterinary public health labs had the capacity to find parasites in animal products and foods for the Indonesian Government.

Nepal is endemic with neglected foodborne parasitic zoonoses. Priority diseases include cysticercosis, hydatidosis, trichinellosis, toxoplasmosis and trematodes. Eight out of 17 administrative regions in the Philippines are endemic for paragonimiasis.

Because of Thailand’s tradition of eating raw fish and meats, there is a relatively high burden of neglected foodborne parasitic zoonoses but the Republic of Korea has seen a decline in parasitic infection rates.

Vietnam has a significant burden, with 1 million to 2 million people estimated to be infected with clonorchiasis and opisthorchiasis in 32 provinces. A total of 51 of 63 provinces report human cases of fascioliasis, 50 provinces have cases of cysticercosis, and 28 Northern provinces report echinococcosis. Challenges to controlling foodborne parasitic zoonosis include the cultural habit of eating raw fish, raw meat and uncooked vegetables and the practice of using human and animal feces as fertilizer and allowing pigs to roam freely in rural areas.

Recommendations included strengthening political commitment to speed up prevention and control of neglected foodborne parasitic zoonoses; improving surveillance and diagnostic capacity for early case detection and identification of active transmission; enhance health and food safety risk communication targeting farmers and consumers and identifying practical, feasible and cost-effective interventions and monitoring and evaluating approaches to assess their local impact.

For 2020 to 2025, country-specific actions in Bhutan include a nationwide prevalence study for echinococcosis and creation of neurocysticercosis surveillance in Malaysia.

In India for 2018 to 2020, priority actions included mapping the disease burden in the country. The target for Myanmar was establishing regular food safety inspection and relevant laws and regulations by 2021. In 2019, Philippines planned to enhance the meat inspection reporting system to include cysticercosis and foodborne trematode infections.