Surveillance of Food and Waterborne Pathogens in North-EastIndia:Protocol for a Laboratory-Based Sentinel Surveillance Study

Background: Food safety is a global concern, which is often underestimated owing to challenges in investigating foodbornediseases. These challenges arise from the increased globalization of the food trade, advancements in agricultural practices, andshifts in environmental factors. In North-East India, common diarrheal outbreaks from fermented foods pose significant healthrisks. Despite these challenges, systematic data on foodborne pathogens is lacking in India, highlighting a crucial gap inunderstanding food safety issues. Objective: The aim of this research protocol is to establish an integrated surveillance system to identify enteric pathogenscirculating within humans, food animals, and the environment through a health approach in North-East India, and to conductoutbreak investigations. Methods: The Indian Council of Medical Research (ICMR) initiated a surveillance study across all 8 North-East states in India,employing a centralized digital database for data collation. The project aims to enhance theinfrastructure for microbial culture,antibiotic sensitivity testing, and molecular epidemiological studies. The study involves laboratory-based surveillance of foodbornepathogens in market foods, hospitalized diarrheal patients, poultry and animal farms, slaughterhouses, butcher shops, and diarrhealoutbreaks. A standardized case report form ensures consistent data collection of age, sex, signs, symptoms, and admission datesfor diarrheal cases. Stool and rectal swabs will undergo testing for pathogen identification and antimicrobial resistance. Similarly,samples of market foods, food animals, and the environment will be collected. Outbreaks confirmed by the Integrated DiseaseSurveillance Project (IDSP) will be thoroughly investigated following standardized guidelines. Results: In phase I, 5 surveillance centers were established across 4 states (ie, Assam [Dibrugarh and Guwahati], Tripura,Sikkim, and Arunachal Pradesh) in 2020. Following an interim phase I data assessment and the successful establishment of astreamlined system for data procurement, investigation, recording, and analysis, along with the implementation of regular trainingand monitoring programs, phase II expansion was initiated in 2023-24. This includes the addition of 7 more centers (including3 veterinary centers) in the remaining 4 states (ie, Manipur, Meghalaya, Mizoram, and Nagaland), eventually covering the entireNorth-Eastern Region of India Conclusions: Food and waterborne diseases are a constant public health problem in many countries. Key challenges to theenhancement of food safety policy include the paucity of systematic data and awareness. With this background, ICMR's initiativeis the first systematic surveillance study in the country to adopt a single health approach. Data obtained from this project willhelp to understand the risk of acquiring food and waterborne pathogens, their transmission pathways, and antimicrobial resistancepatterns. The scientific evidence generated through this project will be helpful in formulating and strengthening food safety policyand in initiating government programs to protect the health of the nation. International Registered Report Identifier (IRRID): DERR1-10.2196/56469 (JMIR Res Protoc 2024;13:e56469) doi: 10.2196/56469