Digger Deeper: Canada's Integrated Enteric Disease Surveillance System

In Canada, C-EnterNet, facilitated by the Public Health Agency of Canada, is an integrated enteric pathogen surveillance initiative, similar to the US CDC FoodNet. C-EnterNet’s primary objectives are to detect changes in trends in human enteric disease and levels of pathogen exposure from food, animal and water sources in a defined population, and to strengthen source attribution efforts in Canada by determining statistically significant risk factors for enteric illness. C-EnterNet is designed to be a national surveillance system encompassing five sentinel sites in different provinces, thereby representing 10% of the Canadian population. Currently, C-EnterNet has two sentinel sites in operation in the Fraser Region, British Columbia since 2010, and in the Region of Waterloo, Ontario since 2005. In each sentinel site, enhanced human disease surveillance is performed in parallel with active surveillance of enteric pathogens in various exposure sources. Active monitoring of enteric pathogens on farms (swine, dairy and poultry manure), retail food (raw chicken breasts, pork chops, and ground beef) and untreated surface water is conducted. In parallel, enhanced epidemiological and microbiological data are collected for the human cases, based on a strong collaboration with the local public health unit and both private and public health diagnostic laboratories. The analysis of detailed, risk factor information for reported cases of enteric illness, obtained by public health inspectors using a new tool - a standardized questionnaire, is the cornerstone of C-EnterNet. Continuous surveillance for enteric pathogens in each component provides C-EnterNet with the ability to compare pathogen profiles amongst components and contributes to the understanding of source attribution. These analyses provide benchmarks for measuring interventions, future initiatives and policy development related to food and water safety in Canada.