1. Poultry associated Salmonella outbreak investigation
Marsha Taylor, Jennifer Jeyes, Gwen Barker,
Clayton Botkin, Brian Radke
Case Study
BC Zoonoses Symposium
November 10, 2015
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2. So it begins
April 30
Alberta (AB) informs BC Ministry of Agriculture (MAg) of 5 AB cases of Salmonella Enteritidis (SE) with live poultry contact, 1 case had contact with live poultry in AB & BC.
May 4
IH CD Unit notices an increase in Salmonella cases
MAg contacts BCCDC re: information from AB
BCCDC calls AB for further details on cluster investigation and shares information with IH
cluster of Salmonella cases in Alberta
cases were associated with live poultry
1 had a possible link to a community in IH
On may 4 – due to cluster detection, salmonella was already on IH’s radar.
By May 8, IH identified 4 cases with exposure to live poultry very geographically separate areas. HSDA – Kootenay B(4 cases of Salmonella reported between April 26 & May 2, appear sporadic.)
oundary, East Kootenay, Thompson cariboo shuswap

3. May 5-8 Unclear if these are related to the AB cluster.
IH flags recent and new cases of Salmonella with live poultry contact for review
IH notifies BCCDC of 4 cases of Salmonella with a history of close live poultry contact (in their house, snuggling/kissing).
Store A was identified by one case as a purchase location of live chicks.
None of the four cases were associated with the community initially reported by BCCDC/AB
Unclear if these are related to the AB cluster.
Do we need to ID IH CD Specialists vs simply IH?
IH notifies BCCDC of they have identified 4 cases of Salmonella in their area with a history of live poultry contact bullet shortened.
Is this an appropriate place to put in some pictures of close chick contact?

4. May 11-12 IH identifies: 6 cases under investigation in IH
2 new cases of Salmonella associated with live chick exposure.
2 new chick purchase locations (Stores B & C).
Miller Hatchery and Rochester Hatchery in AB are being named by multiple Salmonella cases as the source for purchasing their live chicks.
6 cases under investigation in IH
BCCDC receives name of hatchery (Miller/Rochester) and feed store that has received chicks (Store A) from AB, shares with IH.
Confirms link between AB and BC cases to common hatchery in AB
“feed store name (Store A) from AB”, I thought the feed store name came from IH’s interview of case, so did AB confirm Store A as a hatchery agent?

5. What questions do you have. What are you concerned about
What questions do you have? What are you concerned about? What would you want to investigate?
Where does hatchery distribute to?-personal use vs. commercial
What kind of exposures do people have at the feed stores?-general public? What control measures are available at the stores?
Are all cases associated with feed stores? How else do people get these live chicks?
Are there cases elsewhere in BC?
Are all the 6 cases linked to the AB cluster/hatchery? Is this a multi-jurisdictional investigation? Need to communicate about outbreak to p. health officials to look for other cases.

6. Hatchery flow Received Eggs Ships chicks/poults External Marketing
Supply Flock
Broilers
Layers
Dual Purpose
Turkeys
Hatchery
Received Eggs
Ships chicks/poults
Catalogue
External Marketing
Client
Via delivery agent

7. May 13-14
BC, AB, SK agree to national outbreak coordination by PHAC including public health and agriculture of each jurisdiction
Who is at risk? How will we communicate the risk?
156 BC towns received chicks
Hatchery will distribute letter to clients regarding Salmonella risk of live chicks.
Concern from cases re: risk of Salmonella and managing risk at feed stores
IH receiving numerous questions from cases about flock management and safe handling of live birds.
IH contacts 2 stores to understand purchaser notification of risk, ongoing chick sale & infection control practices
Collaboration with MAg (contact information, communication package, sampling)
BC, AB, SK were the provinces with cases
Hatchery did supply list of customer to AB Ag-BC was not provided with direct client list due to confidentiality reasons cited by AB.
MAg response similar to 2011 event which involved same hatchery

8. May 19-21 BC prepares letter for hatchery dissemination to customers
IH reports chick sharing/online groups and occupational exposure
Indicates hatchery letter won’t reach all affected individuals
FHA and VIHA both report cases associated with live chicks contact from the hatchery of interest
13 cases in BC, 47 cases nationally
AB, CFIA, PHAC have received media requests, will likely mention BC in their interviews
Letter still believed to be effective means of communication but new information in BC indicates this is not true.
Scope of investigation in BC is expanding-more cases in more HAs
Pressure for media
In our request we thought we were getting all (final) customers and (intermediate) distributors/agents
Deleted
Miller/Rochester Hatchery letters to clients regarding risk of Salmonella from live chicks have still not been distributed.
BC receives list of feed stores, AAF reminds BC that information has business implications and should be considered when contacting. 8

9. May 22-25 Ongoing communication challenges:
Incomplete list of all retail locations that received chicks
Inaccurate information sent to BC clients directly from hatchery
AB requests BC not share name of hatchery in any public communication
Speak to: with respect to hatchery BC customer list, AB clarifies list only includes those that purchased chicks for sale to customers, vs. stores that acted as depot for customer to pick up birds
May 22
BC repeats its request for the BC customer list from AB
Received with a reminder that the information is confidential and has business implications
May 25
BC hatchery letter & fact sheet complete
IH discovers 1 of 4 feed stores identified by BC cases is not on the list of retailers provided by AB
The hatchery mistakenly s the AB gov’t letter to their customers in BC (185) & SK
BC hatchery customer receives from hatchery stating AB is offering free testing and “information from BC government is slow in coming to them”

10. This is an update, I think this spot in the timeline is consistent with the original notice (May 25 BCCDC posted alert re: Salmonella associated with live poultry) do you want to use that?
For editorial purposes, I suggest we include the IHA notice here although it might be a few days early

11. Media
May 20
no longer available
no longer available

12. Should the hatchery be publically identified?
Naming the Hatchery?
Even with PHAC, BCCDC and IH press releases, there is ongoing pressure from the media & the public to release the hatchery’s name
Should the hatchery be publically identified?
Why or why not?
Response
Yes or no
Yes
To inform customers, especially given the lack of timely communication from the hatchery (if hatchery communication had been more timely & effective, would this negate the need for public release?)
To prevent or identify cases No
Public not at risk, only customers (with inadequate hygiene)
Customers should reasonably expect chicks could be infected with zoonotic diseases and practice appropriate personal hygiene
Not illegal to sell diseased animals (contrast with Maple Leaf example where sale of RTE with listeria contravenes legislation)
Negatively impact the hatchery’s business
Could inhibit future hatchery (or other business) voluntary reporting of zoonotic diseases
Other considerations:
Would earlier naming have prevented or identified cases?
Challenge of what name to use given 2 hatcheries & 3 catalogues
Should Sunrise have been included in the naming? [Only Miller & Rochester hatcheries (actually catalogues) were named because they supplied the backyard flocks. Sunrise hatchery supplied the Miller and Sunrise catalogues. Although the latter supplied or potentially supplied infected chicks, because they went to commercial producers, Sunrise catalogue wasn’t named. I suspect Sunrise supplied our commercial producer that we were notified about in the 11th hour.
How did the case get to this point? An impact of allowing the hatchery to confidentially maintain their customer list and controlling communication to their customers?
What if the hatchery had agreed to provide their customer list to the province?
Public health should do the notification as this is a public health, not animal health, matter.
Ultimately, the hatcheries/catalogues (Miller & Rochester) were not publically named until they self-identified by posting information on their websites. Prior to this, they were not publically named because AB put this condition on the release of the information to BC. Those interested in the hatchery ID were directed to call government officials where the ID was revealed. Were any new cases identified in the period from when discussion began about naming the hatchery & their self-identification?

13. How we named the hatchery
BC public health and MAg agree to provide the hatchery names to individuals that call enquiring about the risk associated with their chicks
Ensure people could identify risk accurately
AB’s condition on sharing the hatchery name with BC was that it not be publically released (their legislation supports conditions on info sharing)

14. Naming the hatchery, the rest of the story
PHAC coordinates call with FPT organizations to discuss media and naming of the hatchery. Request is made that hatchery re-consider disclosing their name publically.
Hatchery posts outbreak information to its websites (somewhat) self-identifying its involvement
Could include screenshots of hatchery websites
By June 1, hatchery posts to website days after initial messaging done in BC.

15. May 27-29
May 27
The hatchery’s BC customers number are estimated in the 100s
May 28
1st test kits mailed sponges ordered
May 29
96 kits mailed sponges ordered

16. June 1-3 June 1 1st kit received by MAg for testing June 2
Some kits are improperly packaged
Hatchery letters have been sent to 1,100 BC customers
June 3
No more test kits available

17. Disposition of SE positive flocks
The Ministry of Agriculture needs to provide a recommended approach to owners of SE positive broiler flocks and layer flocks. What are your recommendations & why?

18. June 3-4 MAg begins work on SE carcass disposal options
MoE Hazardous Waste Regulations: each producer requires written authorization from Director for disposal of carcasses

19. June 11 16 cases in BC, 47 cases nationally
MoE finalizes SE disposal options (on-site composting or burial, off-site landfill) & requirements
Kits: 371 mailed, 49 received
Testing results: 10 of 21 kits (48%) SE pos., 11 (52%) neg. for Salmonella
Commercial producers might have received infected chicks

20. Worse than AI
More producers, new clients
Less informed
Less resourced

21. June 16 19 cases in BC, 53 cases nationally
Kits: 472 mailed, 133 received, 51% (39) of 76 SE pos.
Canada Post refuses to deliver SE kits; previous day smelly, wet kits delivered, & deliverer told kits pose a zoonotic risk

22. June 17-19
Kits picked up from Canada Post depot with deliveries to resume next day
Confirmed 1 BC commercial broiler received chicks

23. July 18 19 cases in BC, 61 cases nationally
PHAC declares outbreak over
Receiving about 5 kits/day for testing at AHC

24. Oct 7 Kits: 664 mailed, 491 received as of Sept 23 (74% return rate),
42% pos. for SE, 54% neg., 4% pos. for Salmonella
Cost to AHC
Free kits: $10/kit x 664 = $6,640
Free testing $126/kit x 480 = $60,480

25. Outbreak summary
61 lab-confirmed cases nationally (AB-35, BC-19, SK-5, MB-1, NT-1)
All reported exposure to live poultry prior to illness
Onset dates reported between April 5 and June 17, 2015
9 hospitalizations, 0 deaths
The numbers from the last OICC I saw were 59 confirmed cases with 17 in BC.

26. Integrating animal and human case information
Animal health
flock results
submitter list = exposed population
some submitters volunteered human health information
Public health
Identifiers and exposure information on cases
How do we integrate this analysis to help inform the investigation?
% positive among humans exposed to chicks
Impact of management on outcome of testing
Actions taken at case level
Barriers to sharing info:
Confidentiality on both sides
Pragmatics – less than perfect match of submitter identifiers
(note, MAgri test submitter list is a unique list of about 50% of the small flocks exposed to chicks)

27. Phage typing, MLVA, PFGE WGS One predominate outbreak clade including:
clinical cases from AB, BC, SK, MB, NT
hatchery isolates & all flock isolates from AB and BC (except for 3)
Clinical cases not identified as associated with outbreak?