1. JANUARY 13, 2014 Controlling Vibrio Parahaemolyticus in Massachusetts SUZANNE K. CONDON, ASSOCIATE COMMISSIONER DIRECTOR, BUREAU OF ENVIRONMENTAL HEALTH MASSACHUSETTS DEPARTMENT OF PUBLIC HEALTH 1

2. Outline 2 I. Introduction / Vibrio parahaemolyticus II. ISSC / Model Ordinance III. Roles of Shellfish Control Authority Relative to Vibrio Management IV. Illness Investigation Procedures V. 2013 MA Vp Control Plan VI. Federal Proposals for North Atlantic 2014

3. I. Introduction/Vibrio parahaemolyticus (Vibrio) 3 Vibrio is an emerging, naturally occurring bacterial pathogen often found in oysters harvested from warmer waters. It has caused illnesses in the Gulf Coast and West Coast of the United States for a number of years. It is not related to pollution of Massachusetts shellfish When ingested, Vibrio causes watery diarrhea, often with abdominal cramping, nausea, vomiting, fever and chills. Usually these symptoms occur within 24 hours of ingestion and last three days. Severe disease is rare and occurs more commonly in people with weakened immune systems. About ten percent of cases will develop a blood infection that may require hospitalization Vibrio can also cause an infection of the skin when an open wound is exposed to warm seawater

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5. II. Interstate Shellfish Sanitation Conference (ISSC) 5 27 member states (including producers and shippers of shellfish), FDA, EPA, NOAA, academia, and industry The Model Ordinance (MO) is developed by state regulators and industry members representing each ISSC region FDA evaluates each member state for compliance with the MO on an annual basis If states do not comply with the MO then the federal government intercedes

6. Model Ordinance 6 According to the current Model Ordinance an outbreak of foodborne illness is defined as 2 or more cases (not from the same household) during the season from a growing area Includes procedures for conducting investigations of shellfish-related illnesses and requires states to close growing areas once an outbreak has been associated with a specific growing area The ISSC will be meeting on 1/25/14 – 1/31/14 and modifications to definitions and response actions have been proposed for adoption

7. DPH DMF Responsible for foodborne illness investigations  Licenses wholesale dealers  Conducts shellfish dealer sanitary inspections for Vp Control Plan compliance  Conducts trace back of shellfish in confirmed cases  Collects, reviews and interprets epidemiological data for confirmed Vp illnesses Inspects all seafood dealers/distributers in MA Advises DMF when health risks warrant regulatory action Permits harvesters Permits wholesale dealers in partnership with DPH Classification and monitoring of growing areas Conducts inspections of landing sites for Vp Control Plan compliance III. Roles of Shellfish Control Authority relative to Vibrio Management 7

8. IV. How Does Vibrio Illness Get Reported to DPH? 8 Vibrio illness is a reportable disease in Massachusetts Hospitals, doctors, and laboratories report results to DPH and to the local health department in the town where the patient lives Patients are interviewed and their information is sent to CDC who coordinates information with affected states

9. Illness Investigation Procedures 1) Illnesses are reported to DPH Food Protection Program (FPP) and/or DPH Bureau of Infectious Disease Services (BIDS) 2) BIDS epidemiologists contact local health nurses to conduct personal interviews with those that become ill 3) Following these interviews, FPP, assisted by local boards of health (LBOH), reviews shellfish tags and other shipping records to determine which oysters may be implicated in each illness 4) FPP and LBOH evaluate retail shellfish handling practices, including time/temperature control of implicated oysters 9

10. Illness Investigation Procedures (continued) 5) FPP then evaluates shellfish handling practices and compliance with MA Vibrio Control Plan by all wholesale dealers providing oysters to retail establishments 6) When specific harvesters are identified, FPP and Department of Fish and Game (DMF) evaluate harvester shellfish handling practices and compliance with MA Vibrio Control Plan 7) May result in recalls of implicated shellfish among wholesale dealers and closure of beds by DPH and DMF 10

11. Closure of Duxbury and Katama Bays Why was there an order to close Duxbury and Katama Bays to oyster harvesting? Massachusetts has had an unusually high number of individuals diagnosed with Vibrio parahaemolyticus since the season started 5/31/13 On 8/29 DPH received confirmation of 3 cases tied directly to harvest areas in Plymouth Harbor, Duxbury and Kingston Bays On 9/9 DPH received confirmation of 2 cases tied directly to the growing/harvest area in Katama Bay (V-20) Cases investigated by DPH and DMF each year  2011 – 13 cases  2012 – 27 cases  2013 – 58 cases 11

12. DPH Vp Investigations Summer/Fall 2013 The cases that prompted the closures were among a number of cases that DPH investigated, including:  19 Vibrio cases with some relationship to Duxbury Bay  12 Vibrio cases with some relationship to Katama Bay 12

13. Additional MA Confirmed Cases 2013 Illnesses associated with harvest areas in Buzzard’s Bay (BB), Cape Cod Bay (CCB) and South Cape (SC).  Single illnesses – not considered outbreaks; therefore did not result in area closures. Of the 58 cases reported to FPP, 33 cases were traced back to one or more MA-only growing areas. All of the MA growing areas with illnesses had consumption dates that fell between June 28 th and August 27 th with corresponding harvest dates between June 26 th and August 25 th. 13

14. Opportunities for Time/Temperature Abuse 14 Transport to Dealer Handling at Harvest Handling by Dealer Handling by Retail Establishment Receiving Storage Receiving StorageService Transport by Dealer to Retailer

15. IV. Elements of 2013 MA Vp Control Plan Implemented in Spring 2013 for oysters harvested May 24 – October 20 statewide Harvesters required to:  ice oysters immediately upon landing  Adequately shade during transport  Record time of harvest and/or exposure by tide on harvester tag Dealers required to cool oysters ≤ 50° F within 10 hrs of harvest/tidal exposure May not ship until internal temp of ≤ 50°F is verified by dealer 15

16. Selected Areas Where Vp Control Plans Differ in Other States New York:  Includes quahogs in addition to oysters  Icing required within one (1) hour of time of harvest New Jersey:  No product may be shipped the same day as harvest Virginia:  Morning harvest only Washington:  No reopening of closed areas for remainder of Vp control period during calendar year 16

17. DMF Vp Compliance Monitoring 2013 Landing site inspection totals:  Sites in 15 towns visited;  115 individual monitoring events  52 events with market-sized oysters landed 18 compliant landings (35% compliance rate) (See handout for DMF Vp Compliance Monitoring Form) 17

18. Properly Iced Improperly Iced Adequate Icing of Oysters 18

19. Oyster Culture Practices of Concern Harvesting and culling oysters then re-submerging for future harvest  Intertidal operations – exposure to sun/heat  Subtidal operations – off-site handling/inadequate shading Air drying racks and or bags of oysters for anti-fouling purposes may increase levels of vibrio Culture practices on floating structures (“oysterplexes”) may also contribute to increasing vibrio levels 19

20. V. Federal Proposals for North Atlantic 2014 Immediate icing of oysters within 1 hr of harvest (#13-204) New procedures for closing and reopening areas with 3 tiers that include consumer warnings in advance of closures and recalls (#13-101) Adoption of 2011 interim time/temperature changes into next version of the Model Ordinance (#11-201A, 11-201B) Use of ice slurries for cooling shellstock (#13-208) Re-submerging of shellstock (#13-209) Bulk tagging for transport to Original Dealer (#13-211) Vp Control Plan for Quahogs (#13-221) www.issc.org 20

21. Outreach in 2014 Industry  Listening sessions in January 2014  ISSC update and discussion – February 2014  Education and training sessions for 2014 Vp Control Plan - spring 2014 Local boards of health  MA Health Officer’s Association training seminars – April 2014  Request that local boards of health provide training to retail food establishments 21

22. Discussion of Issues for Consideration Vp Control Plan 2014 Definition of adequate icing Definition of re-submergence Air drying for removal of fouling organisms Permissible culture practices on floating structures (“oysterplexes”) during Vp season

23. Discussion

24. For additional information, please contact the Bureau of Environmental Health at (617) 624-5757 or e-mail vibrio.feedback@state.ma.us vibrio.feedback@state.ma.us