London 2012: monitoring food and water safety at the Olympic Games Dr Caroline Willis Food Water & Environmental Microbiology Laboratory Porton September 2013

Public Health England Established on 1st April 2013 Executive agency of the Department of Health Includes staff from more than 70 previous organisations Working on health protection health improvement addressing health inequalities

Food Water and Environmental Microbiology Service Testing: testing of food, dairy, water & environmental samples for Local Authorities, Port Health Authorities, hospitals and commercial customers Advice: Significance of results and appropriate control measures; including evidence in court Training: Training of partner organisations Information: Results from investigations and surveys provide a wider picture of changes which may affect public health Research and development

It all started eight years ago…. 6th July 2005: London announced as the host for the Olympic Games 2012 We all celebrated….. ….then, it hits home that we have only 7 years to prepare for and to deliver a safe Olympic and Paralympics Games in Summer 2012!

London 2012 Games = MASS GATHERING! 27th July - 9th September 2012 10 million Olympics & Paralympics tickets 0.9m-2.8m overnight visitors to London: 35% overseas Up to 900,000 spectators and volunteers attending on any one day 400,000 athletes and staff 27,000 media The London 2012 Olympic and Paralympic Games, to which I will from here on refer to as the Olympics will take place between 27th July, the day of the Olympics opening ceremony, to 9th September, when the Paralymics closing ceremony takes place. It will be huge. In total, 10 million tickets for the Olympics and paralympics were available. Most of the events will take place in Londoen & SE England. That will bring a larg influx of people to london: between 0.9 and 2.8 m overnight visitors, of which estimated 35% overseas. There will be hundreds of thoushandsan spectators, volunteers, athletes and staff. And on top of that we will have to deal with the pressure of 27,000 media! This is mass gathering! = MASS GATHERING! 5 5

Infectious diseases and mass gatherings Types of mass gatherings and potential infectious diseases Examples Infectious disease risks Religious festivals Hajj, Christian festivals, Kumbh Mela Respiratory infections, gastrointestinal illness Sporting events Olympics, soccer world cup, cricket world cup Music festivals Glastonbury, UK; Summerfest, USA Sexually transmitted infections, respiratory infections, gastrointestinal illness Trade meetings World Expo Respiratory infections, measles Abubakar et al., Lancet Infectious Diseases 2012 12:66-74 6

Public Health and the Games Infectious disease one of the key risks to the Games Communication with other Olympic Games hosts identify key risks Commonwealth Games 2010 importance of planning & meeting deadlines 7

Role of the HPA was to provide public health governance to the Olympic and Paralympic Health Programme Work streams included: Risk management Surveillance Diagnostic capacity reporting Responses Emergency planning Exercises and testing Communication Finance 8

Food and Water Microbiology and the Games Risk assessment identified need for: Advice, training and support Transport and logistics Rapid testing and reporting Information management Scale up for incidents Monitoring Incidents and outbreaks 9

Advice & Support Olympic Games Paralympic Games National on-call rota of FW&E microbiologists 24 hours, 7 days per week Olympic Games Paralympic Games 10

Training Training for key stakeholders Joint Local Authority of Regulatory Services (JLARS) London Organising Committee of the Olympic Games (LOCOG) Local & Port Health Authorities HPA FW&E Microbiology Service staff 11

Advice, Training & Support Service User Manual Guidance notes for sampling officers On-call sampling support Evidence based focus for sampling activity surveys of mobile catering at large scale events 12

Sampling support Mobile filtration equipment for on site sampling of swimming pools 13

Large Scale Events Survey 2009 Unsatisfactory Between July & September 2009 139 large events 318 vendors Total 1,364 samples: 457 foods 232 waters 536 swabs 139 cloths Satisfactory

Large Scale Events Survey - Timing of sampling 57% of samples collected “out-of-hours”

Follow-up Study of Large Events 2010 Between May & November 2010 153 large events Total 1,662 samples: 659 foods 209 waters 585 swabs 176 cloths 33 swabs of wrist bands worn by food handlers

Comparison of consecutive studies Study % Satisfactory Food Water Swabs Cloths Mobile Vendors 2002 N/A 50 Mobile Vendors 2006 46 13 Large Events 2009 90 48 62 29 Large Events 2010 91 73 68 44

On Park Training and Support 18

Transport and logistics Exercises in early 2012 to test transport systems Daily collection from JLARS for samples from Olympic Park and other London Olympic venues Successful transport of all samples, including at weekends and Bank Holidays, despite road closures and diversions Additional sampling supplies provided to sampling officers, including grab bags containing key consumables & additional cool boxes to facilitate increased sampling Accreditation for three members of staff to have access to the Olympic Park & other venues to support sampling activity, as appropriate 19

Rapid testing and reporting Real-time PCR implemented for rapid screening of enrichment broths for foodborne pathogens Rapid reporting mechanisms agreed with JLARS and other Stakeholders to ensure interventions could be undertaken in real-time Good communication lines to provide advice and support sampling activity 20

Information management Activity a part of the overall health protection support by the HPA Involvement in daily HPA situation reporting Mechanism to deal with queries and ensure consistency in advice to stakeholders Daily spreadsheet of interim and final results to JLARS and other sampling officers across Local Authorities Clear communication lines through dedicated e-mail accounts Full traceability of all information flows 21

Microbiology Services Food and Water Laboratories Microbiology Cell Operations Reference Laboratories Clinical Laboratories 22 22

Scale up for incidents Five Official Control laboratories in England Two sites (London and Porton) directly involved in delivery of testing for Olympic venues Ability to transfer work between sites to enable handling of large scale incident Tested through pre-Games exercises 23

FW&E Microbiology Service Olympic activities All five laboratories involved in responding to Olympic-associated incidents in their local area Most affected London and Porton Approximately 12% of total work of London (April – August 2012) related to Olympics

Monitoring activity In collaboration with JLARS, Local Authorities, Port Health Authorities and the Drinking Water Inspectorate Drinking water monitoring on Olympic sites, particularly the Park Verification of the commissioning process Results converted into public health interventions Re-laying of water pipe runs Assurance of cleaning for drinking water fountains & outlets Evidence for public information on suitability of sources for drinking 25

Monitoring activity Water, food and environmental monitoring Marinas, hotels, training camps and ships used by competitors and Olympic venue staff Swimming pools, Spa pools Water systems, Food service Mobile food vendors around routes for: Torch relay, Cycling events Running events Sea water monitoring (Weymouth) 26

Outbreaks & incidents Joint activities with stakeholders Four hygiene problems with food manufacturers in Olympic food chain two sandwich producers, one meat pie producer one sliced meat producer Microbiological results & advice to Local Authorities, Food Standards Agency and Health Protection Units Resulted in improvements in manufacturing environments No adverse impact on public health detected 27

Outbreaks & incidents Two norovirus outbreaks amongst athletes Advice to Local Authorities and Health Protection Units Hygiene screening in hotel kitchen and food service environment Legionella pneumophila detected in a ship water system Ship providing accommodation for Olympic staff Results from routine monitoring Advice to Port Health Authority and Health Protection Unit No cases identified 28

The Legacy Improved links with key stakeholders Proven capability of the Agency Trained, competent individuals Experience of large scale events and incident response Implementation of rapid methods Improved communication capability Experience of command and control situations 29

Thanks to all colleagues for all their hard work and a shared experience