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

2. 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

3. 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

4. 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!

5. London 2012 Games = MASS GATHERING!
27th July - 9th September 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

6. 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 :66-74 6

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

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

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

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

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

17. 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

18. On Park Training and Support18

19. 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

20. 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

21. 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 accounts Full traceability of all information flows 21

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

23. 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

24. 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

25. 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

26. 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

27. 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

28. 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

29. 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

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