An Integrated Response Outbreak Response An Integrated Response RRT Investigation Team GDA GDPH FDA USDA Other Local Health Dept

Anatomy of an Outbreak investigation Disease Surveillance CDC gathers data from States Epidemiological investigation CDC & States conduct epi studies and FDA reviews Laboratory Analysis Clinical, food, and environmental Initial Environmental investigation State/locals evaluate at Point of Service for contamination Traceback / traceforward FDA, States and industry track product Product & Source investigation FDA and States look for source of contamination

Traceback vs. Traceforward A traceback investigation starts with the consumer or the point-of-service and traces the distribution of the product back to the source. This is the process used in response to a foodborne illness outbreak. A traceforward investigation begins with the source/farm or manufacturer/distributor and traces forward to the consumer. This process is used for a product recall and it can also be useful in outbreak investigations. Traceability has been a useful tool for many industries particularly when a product recall becomes necessary. FDA’s early tracing activities were primarily “trace forward,” tracing a product from the source/manufacturer to the consumer. These tracing activities were focused on recalling affected lots of foods, drugs, medical devices, and biologics. A traceback is working in the reverse – starting from the consumer’s point-of-purchase and going BACK to find the common point in the supply chain, such as the manufacturer or growing farm (source).

Information Collection Traceback Investigation Records of Outgoing & Incoming Shipments of cilantro during from 5/19/15 to 6/30/15 Invoices Bill of Ladings Trip Tickets Packing Slips Purchase Orders Decipher & Analyze What do dates mean? Is Invoice Date & Shipping Date the same?

Traceback Flow Diagram Farms POS Distributors Packers This is an actual traceback flow diagram from a produce outbreak, minus the specific info that would normally be in each box. The POS represents the Point of Service and then we work back in the supply chain to find a common pt. You can see there’s several levels of distribution before you find convergence. We’re often asked “Why does it take so long” well, this is one reason…all the information/records need to be collected from multiple points in the supply chain before the puzzle pieces connect. As FYI, this traceback led to a produce farm investigation as well as a recall, consumer alert, and import alert.

2014-2015 RRT Responses at a Glance What: FL RRT and VA RRT notify GA on Listeria mono found on soft cheese products. Illness in GA. Who: FL RRT, VA RRT, GA RRT (GDA – Manuf., GDPH – Epi, FDA ATL-DO) Fred Omatao Action: GA Distribution, Visit Firm, Traceforward Investigation

2014-2015 RRT Responses at a Glance What: Norovirus Oyster Outbreak. FDA CORE Assignment to GA RRT investigate firm Who: WA RRT GA RRT (FDA ATL-DO, CORE, GDA – Seafood) Action: Visit Firm, Environmental Assessment, Traceforward, Traceback, Implicated Product Identified Tony Colvin!!!

2014-2015 RRT Responses at a Glance What: Ciguatera Fish Poisoning Outbreak in FL Who: FL RRT & GA RRT (FDA ATL-DO, CORE, GDA – Seafood) Action: Visit Firm, Environmental Assessment, Traceforward, Traceback, Tony Colvin!!!

2014-2015 RRT Responses at a Glance What: Fresh Cheese Curd Recall Listeria mono Who: FL RRT & GA RRT (FDA ATL-DO, GDA – Manufacturing Program) Action: GA Distribution, Visit Firm, Traceforward Investigation, Recall Effectiveness Check Tony Colvin!!!

2014-2015 RRT Responses at a Glance What: Salmonella Pet Treat Feed Recall Who: VA RRT & GA RRT (GDA – Feed Program ) Action: GA Distribution, Stop Sale Issued, Recall Effectiveness Tony Colvin!!!

2014-2015 RRT Responses at a Glance What: Multi-State Listeria mono Outbreak & Blue Bell Ice Cream Recall Who: GA RRT (GDA – Retail, GDPH – Food Service) Action: GA Distribution, Press Release, Massive Coordinated Recall Effectiveness Check Tony Colvin!!!

2014-2015 RRT Responses at a Glance What: Multi-State Listeria mono Outbreak w/ GA illnesses and Hummus Dip Recall Who: GA RRT (FDA ATL- DO, GDA – Retail, GDPH – Epidemiology) Action: GA Distribution, Press Release, Recall Effectiveness Check Tony Colvin!!!

2014-2015 RRT Responses at a Glance What: Multi-State Cyclospora Outbreak. GA Cluster and investigation Who: GA RRT (GDPH – Epi, GDPH – EH, Fulton Co. EH, GDA – Manuf. Program, FDA ATL-DO, FDA CORE Action: Environmental Assessment, Epidemiologic Investigation, Record Review, Traceback Investigation Tony Colvin!!!