OUTBREAKS INVOLVING FOOD & LODGING ESTABLISHMENTS PARTNERSHIPS NEEDED FOR A SUCCESSFUL INVESTIGATION Carl Williams Melissa Ham Nicole Lee
Presentation Content Why do we care about foodborne outbreaks? What partners need to be involved and why? How does this partnership work during an outbreak? What are some common conflicts between partners? Are there resources for partners? Q & A
Why do we care about foodborne outbreaks?
Potential illness reaching the masses Intentional vs accidental contamination Possible wide distribution of a contaminated item Vulnerable populations Loss of days worked, wages, business, trust
Real Life Events: Salmonella
Total Ill 100 Hospitalized 8 Counties Represented 11 Ages 17yrs-81yrs Median: 45 yrs
Real Life Events: Salmonella
Total Ill 104 Hospitalized 14 Counties Represented 5 Ages 3yrs – 85yrs Median: 55yrs
Real Life Events: Norovirus
Real Life Events: Hepatitis A
What partners need to be involved and why?
What partners need to be involved?
Laboratory
What partners need to be involved? Environmental Health Laboratory
What partners need to be involved? Epidemiology Environmental Health Laboratory
What partners need to be involved? Epidemiology Environmental Health Laboratory
What partners need to be involved? Epidemiology Environmental Health Laboratory
What partners need to be involved? Epidemiology Environmental Health Laboratory
What partners need to be involved? Epidemiology Environmental Health Laboratory
Purpose of partners Agent specific Verify diagnosis Outbreak specific Identify source Implement control measures LaboratoryEpidemiology Facility specific Identify exposure and transmission opportunities Implement control measures Environmental Health
One example… When has this worked?
Real Life Event: Salmonella
Monday, May 13, 2013 Day 1
Fifteen ill with N/V/D (some bloody) 10 / 15 hotel staff (3/10 food handlers) 1 hospitalized Two of three samples (+ Salmonella) May 8 th was the first onset 4pm - Conference call Local Health Dept: Epi, Env Hlth State: Epi, Env Hlth, Lab, Public Affairs 10:00am – Call from CD Nurse
Day 1 Summary of Actions/Decisions Confirm the story Implement control measures with hotel/rest. Interview ill Coordinate hotel assessment with Env Hlth Coordinate stool specimen collection, shipment, and testing with state lab Develop communication tools Send statewide & national alerts to identify additional cases Request receipts from hotel (case-control study) Develop survey from hotel menu Send state staff to Cumberland to assist with summarizing data and data entry
3 Partners with 1 Goal Food & Lodging Outbreak Laboratory Test stool samples Environmental Health Assess facilities Epidemiology Coordinate activities Interview patients Characterize ill Stop the Outbreak
Activities of partners Test stool Grow isolate Biochem tests Subtyping PFGE Environmental testing (partner labs) Coordinate activities Characterize illness Analyze data from all partners LaboratoryEpidemiology Facility Assessment Processes Employees Environmental Health
Results Laboratory Environmental Health Epidemiology
Laboratory Results 54 specimens tested 2 (4%) unsatisfactory 27 (50%) negative 25 (46%) positive 25 (100%) Salmonella typhimurium 25 (100%) had the same matching PFGE pattern
Environmental Health Results Environmental Assessments Risk Factors Personal Hygiene Approved Source Contamination Holding Cooking Interviews Trainings
Environmental Health Actions Required reportable BIG 5 Tools Three legged stool Employee Health Hand washing No Bare Hand Contact of Ready to Eat food Risk Control Plans Enforcement
Epidemiology Results Total Ill 100 Hospitalized 8 Counties Represented 11 Ages 17yrs-81yrs Median: 45 yrs Exposure Relative Risk FOOD Employee Potluck0.62 Café Breakfast Buffet0.89 Café Lunch Buffet1.09 All American Grill 3.6 WORK TASK All American Grill Supervisor 4.3 RESULTS Those who ate/drank at the All American Grill were 3.6 times more likely to become ill when compared to those who did not eat/drink at the All American Grill
Process Results After outbreaks are over the following questions are asked of those involved: What worked well during this outbreak? What did not work well during this outbreak? What recommendations do you have to improve the handling of future outbreaks?
What are some common conflicts between partners?
Potential conflicts with partners Not aware of numerous incoming specimens Specimens may be un- satisfactory Interest in accompanying EH during facility assessments Timing of lab results can feel delayed LaboratoryEpidemiology Expanded workload Additional team members on site Environmental Health
Potential conflicts with partners Feels like state is taking over instead of assisting Nursing staff pulled from clinic to address outbreak needs Ensure the county is happy with how the outbreak is lead Ensuring the same message is communicated to the public Local Health DeptState Health Dept
Conflict resolution Establish relationships with partners before or outside of an outbreak situation Who is your point of contact and what can they do for you Understand the role of each partner What do they do and why Do they have the resources the response requires Communication How often is everyone updated and through what method Take the opportunity to both learn from others and share your knowledge
Are there resources for partners?
Partnership Resources SLPH website CDC resources MOA with other states for surge capacity NC Online Communicable Disease Manual APHL Control of Communicable Disease Manual LaboratoryEpidemiology NC Food Code Online EH training for Assessments during Outbreaks gov/nceh/ehs/e Learn/EA_FIO/ gov/nceh/ehs/e Learn/EA_FIO/ Environmental Health
Partnership Resources LaboratoryEpidemiology Environmental Health
Partnership Resources LaboratoryEpidemiology NC Food Code Cheat Sheet Environmental Health
Q & A?
Carl Williams, Public Health Veterinarian Melissa Ham, Regional Environmental Health Specialist Nicole Lee, Foodborne Epidemiologist Thank You