1. Live on Channel 10 news tonight: Effect of media attention on outbreak investigations On April 21, 2005, the Maricopa County Department of Public Health (MCDPH) Office of Epidemiology (Epi) initiated an epidemiologic investigation at a chain restaurant following two separate complaints from patrons. Following an initial site visit by the Maricopa County Department of Environmental Services (ES), Epi and ES returned for a follow-up site inspection and conducted interviews with employees at that time. On May 7, an article appeared in a local newspaper stating that the restaurant was closed and an "older" patron who reported illness after eating at the restaurant died (exact cause of death unknown). This article prompted additional illness complaints to the restaurant's corporate offices and to MCDPH. When the AP wire and the local television news picked up the story, the restaurant's corporate risk management (RM) department increased its involvement in the investigation and response. Epidemiologists worked closely with the facility and RM to implement an exclusion rule for ill employees and to deal with frequent requests for information from the corporate offices throughout the investigation. The media exposure also required epidemiologists to work closely with the MCDPH Public Information Officer (PIO) as well as the MCDPH Director. At this point, the number of complainants increased greatly. The total number of individuals reporting disease tripled (from 33 to 92) within 14 days after the media reports. Most of these persons had onset dates several weeks before the news stories appeared, but did not call the MCDPH until after hearing the news. Involvement of the media in an outbreak investigation could potentially cause an increase in the number of spurious calls. In this investigation, six reports (6.5%) were unrelated to the current investigation, as determined by onset dates incompatible with the outbreak. (However, the percent of spurious calls in outbreaks not receiving media attention is unknown.) Jeanette Gibbon, MPH 1, Jennifer Stewart, MS 1, and Mare Schumacher, MPH 1. (1) Office of Epidemiology and Data Services, Division of Disease Control, Maricopa County Department of Public Health, 4041 N Central Ave, Suite 600, Phoenix, AZ 85012 Summary of Events Future Recommendations Statistics Impact of Media Exposure Introduction When large outbreaks attract media attention, the impact on outbreak investigators can be great. This media attention can help in identifying cases, yet can also increase the complexity of an investigation. Press releases, increased case reports, the involvement of the director and public information officer, and when chain restaurants are involved, frequent demands from restaurant corporate headquarters are added elements. Increased concern among the public about the food safety at the implicated restaurant. Increased need for public information. Investigators were giving information to PIO daily. Publicity greatly increased case finding. Additional resources had to be devoted to public relations as well as to traditional epidemiologic activities (i.e. many additional interviews). Increased communication between Epi staff and the risk management staff for the restaurant. Establishing good relationships with corporate RM provided many benefits including access to information from corporate complaint line and data collected during the corporations internal investigation. Relationship with RM also ensured cooperation of local restaurant management, although long term effects are uncertain. A follow-up inspection less than a month after the investigation revealed several violations. Requests to complete the investigation report in a short time period occurred, particularly requested by RM and attorneys working on potential law suits by patrons. Prior to the media exposure on Saturday, May 7, 2005, interviews for all those registering complaints with Environmental Services and employees of the restaurant were completed (n=33). Within 14 days after the media reports, which provided a 1-800 number to submit complaints, 59 additional interviews were completed for a total of 92. Essential to plan for media attention as early as possible in an outbreak investigation Recognize when investigating an outbreak in a chain restaurant that corporate RM will be involved and establish a point person early. (Of course, this is the case with any corporate chain restaurant, regardless of media involvement, but involvement may be more intense with media exposure.) Assigning one point person to communicate with the PIO helps both Epi and the PIO and ensures a single voice. Assume increased case finding and need for additional resources. Timeline DateAction 4/15/05First exposure and onset of illness related to investigation 4/19/05First complaint received by ES 4/21-4/26/05Four additional complaints received by ES 4/21/05Epi notified of outbreak; investigation initiated 4/22/05First site visit by ES 4/24/05Death of patron 4/27/05During interviews, earlier fatality of a restaurant patron discovered. Site visit by Epi and ES. Initial contact by corporate risk management (RM) to ES 4/28/05Autopsy of decedent; prelim results positive for norovirus 4/29/05Restaurant closes voluntarily for cleaning 5/2/05Restaurant reopens. Additional Epi staff added for short follow-up interviews with employees 5/3/05RM sends spreadsheet of ill employees to Epi. Epi identifies point person to communicate with RM 5/4/05RM calls Epi for update. Last onset of illness related to investigation 5/5/05Epi calls RM for information and in the process RM requests more information 5/7/05Article in local newspaper. AP wire picks up story. MCDPH PIO completes interviews with TV stations for later newscasts 5/9/05RM calls Epi to report influx of calls to 1-800 line after media exposure. Additional Epi staff added to complete interviews, etc. 5/27/05Data entry complete 6/1/05Investigation closed 6/22/05ES follow-up inspection reveals restaurant still in violation of food code 6/23/05ES follow-up inspection, all violations corrected Media Coverage On May 7, 2005, a local newspaper published an article entitled Virus shuts down Mesa restaurant. The article included the name and location of the restaurant, that one patron had died and 26 reported illness, the fact that the restaurant was closed voluntarily, and the diagnosis of norovirus for the deceased patron. The article was picked up by the Associated Press. Additionally, the MCDPH Public Information Officer conducted interviews for Channel 3 and 10 local newscasts to run on the same evening. HEALTH ALERT Although most onsets occurred between April 16 and April 28, most reports were received after the media exposure.