Wednesday, 10 November 2004
Dáil Eireann Debate
Dr. Upton asked the Tánaiste and Minister for Health and Children the action that has been taken to identify the source of the variant CJD contracted by a person now being treated in a Dublin hospital; if there is any information as to the way in which the condition was contracted in this country; and if she will make a statement on the matter.
Ms McManus asked the Tánaiste and Minister for Health and Children the action she intends to take arising from the confirmation that a person being treated in a Dublin hospital has variant CJD; if information is available regarding whether the condition was contracted here; if she has satisfied herself that all appropriate procedures are in place to deal with this case and other possible cases; and if she will make a statement on the matter.
Mr. Naughten asked the Tánaiste and Minister for Health and Children the action she is taking to try to identify the source of the variant CJD infection of a person being treated in a Dublin hospital; and if she will make a statement on the matter
Dr. Twomey asked the Tánaiste and Minister for Health and Children if she will make a statement on the incidence of a variant CJD case in a Dublin hospital in the context of more than 100 diagnosed cases in the UK; and her views on whether the incidence of variant CJD will become a greater issue here in the future.
Minister of State at the Department of Health and Children (Mr. B. Lenihan): I propose to take all the questions together. I have learned with regret of the occurrence of a case of variant CJD in a young man in Dublin. I am sure this experience has been most distressing for him and his family. The case concerns a 23 year old man who was admitted to hospital approximately six weeks ago. It has now been confirmed that he is suffering from variant CJD and the probability is that he contracted it before the current very strict controls on the sale of meat in Ireland were brought into force in 1996. Given that the typical incubation period for variant CJD can be as much as ten, 15 or 20 years, it is impossible to identify a specific source of infection. However, the CJD advisory group and the National Disease Surveillance Centre are giving further consideration to this issue. I understand they are meeting as we speak. The clinical management of the case is, of course, a matter for the physicians involved.
The Tánaiste and Minister for Health and Children, Deputy Harney, has been briefed by Professor William Hall, chairman of the CJD advisory group, on any broader public health implications which may arise from this case. The CJD advisory group provides scientific, professional and technical advice on all aspects of CJD to the Department, and the policy responses that are appropriate in the light of the evolving information and evidence on this topic. I reassure the public that there are no public health issues in this case. The patient has never received a blood transfusion, was never a blood donor and has not received any invasive medical treatments, including major surgery. There is no risk of onward transmission, therefore, with regard to this case.
New variant CJD is a rare degenerative fatal brain disorder in humans. It is believed that the vast majority of persons who have developed variant CJD became infected through the consumption of cattle products contaminated with the agent of BSE. The Food Safety Authority of Ireland and the Department of Agriculture and Food are responsible for BSE controls in Ireland. The FSAI stresses that BSE controls in place in Ireland since 1996 are very strict and that there are layers of robust control measures to ensure maximum consumer protection with regard to BSE. The incidence of BSE continues to decline in the Irish cattle population, demonstrating that the controls introduced in 1996 and 1997 are working. There are fewer cases of BSE and the vast majority of current cases are in animals born before the introduction of these enhanced controls.
One of the key factors for establishing the Food Safety Authority in 1996 was the BSE crisis. The authority bases its decisions upon the best scientific data and knowledge and develops inspection and audit controls to ensure maximum consumer protection in regard to meat and meat products. A rigorous policy of safeguards is now firmly established throughout the food chain.
In Ireland, there is a sequence of controls for BSE along the food chain. Feeding of meat and bonemeal to all farm animals is prohibited. There are stringent controls at rendering plants and feed mills. The main consumer protection measure has been the removal of specified risk material from the human food chain. This material is the parts of an animal most likely to contain BSE infectivity if that animal is incubating the disease.
Veterinary inspectors examine all cattle before slaughter at the abattoir and rapid BSE testing is carried out on all animals over 30 months of age. The inspectors, under service contract to the Food Safety Authority, ensure that slaughtered cattle have had the SRM removed. At boning plants, the carcases are inspected again. In butcher’s shops, environmental health officers under contract to the Food Safety Authority inspect carcases at this level. In addition, all butchers operating in Ireland are aware that it is illegal to sell meat products containing SRM. The Food Safety Authority and the Department of Agriculture and Food have been to the forefront in the European Union with the most aggressive controls to protect both animals and humans from the BSE agent. The Food Safety Authority, the Department of Agriculture and Food and the other agencies involved in policing the food chain are working together to ensure full compliance and maximum consumer protection.
The Tánaiste has also been assured by Professor Hall that the measures in place to protect public health, especially in regard to the protection of the blood supply, are in accordance with best internal practice. A number of technical sterilising measures are taken on blood supplies and a number of donor deferral measures, especially in respect of persons who have lived in the United Kingdom, form the cornerstone of this activity.
Following preliminary discussions with Professor Hall and the medical director of the Irish Blood Transfusion Service, the initial conclusion is that the position presented by the occurrence of this case does not require that any other measures apart from those already in place need to be taken. The Irish Blood Transfusion Service undertook a review of its policies following the case of transfusion infection in the United Kingdom last year and will continue with these policies.
The CJD advisory group has recently endorsed the most up to date infection control guidance in respect of the management of CJD in the hospital setting. The Department of Health and Children is ensuring the circulation of the guidance through the hospital system. The disease continues to be notifiable and the national CJD surveillance unit in Beaumont Hospital continues its activity in monitoring the occurrence of CJD in Ireland.
Dr. Upton: I thank the Minister of State for his reply to my question. I express sympathy to the victim and to his family. This is a very distressing time for them. We will do everything we can as public representatives to ensure their privacy is respected.
Presumably at this stage, all other events in terms of hospital treatment, blood transfusions and so on being excluded, it is fairly clear that the source of the infection must have been meat. Is there a view on whether that meat could have been imported? What level of imports would there have been during the period in question? I refer to imports from the UK in particular since it is where the largest number of cases of BSE occurred during the period in question.
Is the Minister of State satisfied that we now have in place all the relevant stringent conditions to ensure that any other meat imports or animal feed are meeting the highest standards? Is he also satisfied that there is no further concern regarding meat or animal feed imports now or into the future?
A relatively recent event relating to the importation of animal feed gives rise to some general concern if not specifically in regard to BSE. I refer to beet pulp that was found to have traces of bone in it. This would be totally unacceptable in the context of the reasons we banned meat and bonemeal. Do we have an assurance that there are in place rigorous conditions and monitoring systems to ensure that such an event cannot recur?
Mr. B. Lenihan: I made clear that it is a matter of probability that the origination of this CJD was in meat. However, we cannot say that as a matter of certainty because it is almost impossible to trace so far back the source of what has caused this infection. As a matter of probability it is probably safe for us to draw that inference and as persons responsible for putting controls in place, we must draw that inference.
That leads me to the second question posed by the Deputy regarding importation. Clearly, we cannot draw any conclusion about that. I am quite satisfied about the procedures that now apply to the importation of food products into Ireland. A robust system is in place. I made that clear in my reply. In regard to animal feed, its importation generally is a matter for the Minister for Agriculture and Food; it is not a matter for the Food Safety Authority or the Department of Health and Children.
Regarding the last point made by the Minister of State, will he explain how the Department of Health and Children liaises with the Department of Agriculture and Food on an issue such as this? I imagine a central feature that would need to be established is that there would be full co-operation.
Is there anybody else in the country who is suspected of having this condition, or is this the only case? This case has been the subject of considerable media discussion today. A point that has arisen, which might be worth considering, is that there has been a black market in sales of meat from time to time, with meat being illegally sold in housing estates and other such activity, although it does not currently seem to be prevalent. Has the committee carried out an assessment about those types of sales and the sourcing of such meat?
Mr. B. Lenihan: This is the only case that has been brought to the attention of the Department or the Minister. It was brought to the attention of the Minster some weeks ago. As I indicated in my reply, the Minister met Professor Hall at the time, but out of respect for the privacy and confidentiality of the relationship between this young man and his medical advisers, and because there was no issue in regard to public health, the information was not disclosed at that stage by the Minister or the Department. I want to make it clear and put on record that this is the only case that has been brought to the attention of the Minister or the Department. If there were another case, it is likely it would be brought to our attention.
Deputy McManus referred to black market operations in meat. Operators or persons who engage in this activity would be engaged in a conduct that amounts to a criminal offence. If there is any information in that respect, the Department will see to it that it is followed up.
Mr. Naughten: On my behalf and on behalf of the Fine Gael Party I express sympathy to the victim and his family. Everyone would agree that this is a traumatic position for anyone to find himself or herself in.
Because of the period involved dating back perhaps some 20 years, the probability of contamination from Irish beef is quite slim. Can the Minister indicate the scale of the importation of meat from the UK during that period? Is there a possibility that the infection may have come from the UK and, if so, what would be the scale of that? What action is being taken by the Food Safety Authority of Ireland to address the concerns among the member of the public about the safety of beef products currently on the market?
I have a further question related to previous comments about concern among members of the public regarding beef. Is it possible that some products labelled as Irish could have come from the United Kingdom in that period? Is there not an urgent need for country of origin labelling on all food products purchased in this country?
Mr. B. Lenihan: Country of origin labels are also insisted upon under our present regime. Robust controls are in place so the suggestion which the Deputy hinted at rather than canvassed that the present case might have originated in recent products is not correct. It is a matter of probability that the current case of vCJD was contracted before the very strict controls were brought in by the Government in 1996. Deputy Naughten is anxious to ascertain whether we can say, as a matter of probability, that the present case originated in material imported from the United Kingdom. I cannot say that because it is impossible to trace the source, but it is a strong possibility. I do not have at my disposal the detailed volumes of statistics precisely outlining our importation of meat from overseas markets. However, my advice from the Department is that it is a matter of strong possibility that the disease originated in meat which was imported from the United Kingdom.
It has been pointed out that stringent controls have existed in Ireland since 1996 and one can accept that there is no chance of any person under the age of eight getting this disease from an Irish product. However, we still import foodstuffs from many jurisdictions where bonemeal is used in animal feed. Last week, we discussed the importation of beet pulp which contained bone. In some countries it is still legitimate to use bonemeal in the preparation of animal feed.
This disease, once contracted, is virulent. We are trying to prevent BSE from crossing from the animal food chain to the human food chain. Even though our controls are strict and we have been implementing them tightly to prevent BSE from neural and spinal animal tissue getting into meat, other countries may not be so stringent in keeping it out of the human food chain. As the Minister of State has pointed out, there is a latent period of between ten and 15 years and we have seen several cases of vCJD in the United Kingdom. Has the Minister of State been in discussion with the Ministry of Agriculture, Fisheries and Food or with the Secretary of State for Health in the United Kingdom to see what public health measures have been used to decrease the incidence of CJD in the United Kingdom?
Mr. B. Lenihan: I understand the Food Safety Authority of Ireland has been in discussion with the corresponding authority in the United Kingdom about these issues and maintains dialogue with it. There are also controls in place in third countries outside the European Union. We monitor those controls in liaison with the Commission. We must be satisfied with the controls on products being imported.
Mr. Gormley: Will the Minister of State explain why, if these stringent controls have been in place since 1996, there were 74 cases of BSE at that time, 333 cases in 2002 and 104 cases last year? Why were there three cases of BSE even on organic farms? I was surprised to receive this information in a reply to a recent parliamentary question because I was under the impression that the strictest standards applied on organic farms.
Will the Minister of State reassure consumers about the quality of beef products on the shelves of our shops? The rapid test, which has been approved by the European Commission, is carried out on cattle aged over 30 months. Those are cattle which are killed for human consumption. Are cattle which are killed for use in pet food tested? While I do not profess to being a scientist, I know that the prion survives all rigours, even very high temperatures. If a householder uses a spoon to dish out pet food, is there any danger that the prion from contaminated pet food could survive on the spoon and be transferred to food to be eaten by humans? This question has been put to me.
Mr. B. Lenihan: The advice I have received from those who have expertise in the matter is that there is not such a risk. It is transmitted through blood. The prion, which is a protein derivative from the brain or spinal tissue——
There are fewer cases of BSE in the Irish cattle population and the vast majority of current cases are in animals born before the introduction of the enhanced controls. The Deputy is right in saying there have been very few cases in cattle born after 1997, and the Department of Agriculture and Food is investigating them.
Mr. Crawford: I too express my sympathy with the patient and his family who find themselves in this unfortunate situation. I have asked many questions on the regulations regarding the importation of meat and meat products and I am conscious of the extreme seriousness of this issue. We can trace the country of origin of a product but we cannot trace the farm from which it comes.
In light of the recent contamination of imported sugar beet, are we certain that all meat and bonemeal which leaves this country is used for the production of electricity or otherwise? In exporting all our meat and bonemeal we leave ourselves open because we cannot control what is done to it in other countries.
Irish producers — I am one of them — must adhere to the strictest regulations, and that is only right. However, we must make certain that every consumer of meat and meat products knows that imported products are produced and monitored in the same way. Can the Minister of State assure us of that?
Mr. B. Lenihan: Deputy Crawford is quite right and I welcome his point that producers must adhere to these strict regulations. That is not just in the interest of consumers but of the industry also. We must remember that when discussing imports we are talking about an EU regime. The EU food and veterinary office is the enforcement authority. It is a matter of EU law that any meats imported into any part of the EU must meet the required standard. The standard is not enforced here through the Department of Agriculture and Food or the Food Safety Authority, it is a matter of European law that imports are regulated on a uniform basis throughout the union. The EU standard is policed by the EU food and veterinary office which conducts spot checks. That applies to all third party material coming into the EU. Once it is in the EU, it is subject to the EU standard that is applied in each member state by the relevant authority. That is the answer to the Deputy’s question.
Dr. Upton: I accept that the questions are directed to the Minister for Health and Children but it is difficult to separate the responsibilities, given the importance of this matter. As regards older animals and the epidemiological studies that are being carried out, it strikes me as extraordinary that recently an 18-year-old animal was diagnosed as having BSE. It is inappropriate to have such old animals because the disease normally presents in older animals. Surely, therefore, there is a case for dealing with older animals. Even at this stage, that would take some of the possible sources of infection out of the system.
If I may refer again to the factors surrounding the patient, does the Minister have an opinion on whether a trust fund should be established to ensure this patient, and any future patients who might be unfortunate enough to become victims of variant CJD, will be supported and looked after? The Labour Party has already raised this issue and it is very important in terms of ensuring the safety and security of that family as best we can.
Mr. B. Lenihan: There are about 1 million cattle over seven years of age in the country, which is a substantial number. Therefore, the Deputy will appreciate that the implications of what she is proposing are far reaching. As regards the care and treatment of the patient who has been so unfortunate in contracting this condition, the Department will entertain any reasonable request to ensure that he receives all possible care and attention.
Mr. Naughten: In an earlier response, the Minister of State referred to country-of-origin labels. If we have an accurate labelling system identifying countries of origin, how did the Food Safety Authority detect a significant amount of beef labelled as Irish but which was of South American origin? Will the Minister deal with that question as there seems to be something significantly wrong with the system?
The UK authorities have introduced disposable surgical equipment to reduce the possibility of cross-infection. Has that been introduced here and, if not, are there any plans to introduce it? That would reduce the possible risk of cross-infection between patients in medical facilities throughout the country.
Mr. B. Lenihan: The Deputy is correct in suggesting that foreign meat has been incorrectly labelled. The Department is aware of that. Those who mislabel such products are in breach of the relevant regulations, which are clear-cut. The Department will investigate any such matters that are brought to its attention to see that appropriate enforcement action is taken.
Mr. B. Lenihan: I am glad Deputy Naughten has raised the issue because it has allowed me to put on record the legal position, which is not fully appreciated — that a meat product’s country of origin should be stated. The Food Safety Authority would be delighted to receive any information on this issue and it will act on any information it receives. I urge Deputies and members of the public to co-operate with the authority on this matter.
As regards disposable surgical instruments, strict infection control guidelines are applied and the CJD group has considered this issue. The group’s advice is that it is not essential to use disposable instruments. That is the advice we have received from those with expertise in this matter.
Mr. Gormley: Will the Minister of State clarify his previous answer to me? I think his officials were indicating that cattle chosen for pet food are also tested for BSE. Did I understand the Minister of State correctly in this regard?
Mr. Gormley: I thank the Minister of State for that response. What sort of testing takes place for variant CJD in blood products? Are they rigorously tested because we now know that the disease can be transferred in that way? Is that the case?
Mr. B. Lenihan: It is not always possible to test for vCJD in blood products. That is a scientific difficulty we are faced with as regards blood products specifically and their association with vCJD. Nowadays, however, every possible step is taken to test blood products and ensure they are safe.
Dr. Twomey: Can the Minister of State’s Department, in liaison with the Department of Agriculture and Food, supply a list of countries that are still using bonemeal in animal feed and from which food products originate? Will he also liaise with the Department of Agriculture and Food to obtain an accurate answer as to whether there was any possible risk, or potential risk, to the food chain from foodstuffs that were imported last week but were subsequently returned to their country of origin? I would like to get a clear answer on those matters from the Department.
Dr. Twomey: Last week, beet pulp was imported into this country and traces of bone were found in the load. It was all subsequently recalled but some of it had already been distributed to different parts of the country. Some 4,000 tonnes of the produce was imported but it was all recalled by the Department of Agriculture and Food. There seems to have been some breakdown in the procedures that are normally followed in the importation of such foodstuffs. Will the Minister of State clarify that with the Department of Agriculture and Food? We are trying to keep BSE out of the food chain so that we will not end up with variant CJD in human beings.
Mr. B. Lenihan: As regards the incident to which the Deputy has referred, there was no question of a breakdown of procedures. This discovery occurred in the course of the normal monitoring operation that the Department conducts for this material.
Mr. B. Lenihan: For that reason the Department first of all arranged to impound the bulk of the consignment. In so far as consignments were distributed, the Department is seeking to trace them and bring them in also.
Mr. B. Lenihan: No. The breach of procedure was because of the importer. The Deputy must forgive me for having assumed otherwise. As regards the wider issues raised by the Deputies concerning statistical data on bonemeal use, I will endeavour to obtain that information.
Mr. J. Brady: While I know it concerns a different Department to the Minister of State’s, I have read that there is a possibility that the Department is considering culling all the herds where animals have been fed the imported beet pulp. Is that correct? Further to Deputy Gormley’s question on the testing of animals for pet food, is it not true that even fallen animals are tested for BSE?
Mr. B. Lenihan: The matter of pulp beet is under consideration in the Department and no final decision has been taken. It would not be fair to say a decision has been taken to slaughter any animals yet. Obviously it is an option that may arise. As I explained to Deputy Twomey, the Department is endeavouring to trace, identify and recover the entire consignment.
Mr. Hogan: The Minister’s response to Deputy Johnny Brady’s question would indicate that some of that imported product was fed to animals giving rise to the risk of it turning up in the food chain. I ask the Minister of State or his colleague the Minister for Agriculture and Food to make a statement to the House at the earliest possible opportunity about any developments that have taken place arising from this importation. While it is serious for the beef industry, it is also serious from the point of view of human health.
Mr. B. Lenihan: That is a mater for the Minister for Agriculture and Food. Obviously the Food Safety Authority and my Department in liaison with the Minister will ensure there is no risk to public health in this matter and that every possible step will be taken to protect the public in this regard.
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