1. Environmental Health Role in Investigation & Control of Food Poisoning & Gastrointestinal Infections Hilary Byrne Belfast City Council

2. Scope Legal background and reporting procedures Organisations involved The investigation process Risk groups Control measures Guidance

3. Public Health Act (Northern Ireland) 1967 Doctors have a statutory duty to report notifiable infectious diseases These infectious diseases include food poisoning, and other gastro infections e.g. dysentery, hepatitis A, typhoid

4. Food Poisoning: Notifications and Laboratory Reports 2005 – 2014

5. Investigation jointly by the Public Health Agency & Environmental Health

6. Notification made to the Public Health Agency Recorded on analysis database Referred to relevant Environmental Health Department EHO makes contact or visits case Complete questionnaire & food history Advise on enteric precautions, hygiene measures, exclusions Consider faecal / food sampling as necessary Feed back to PHA Discuss further action Feed back to PHA Discuss further action

7. Reasons for investigation Identify the possible source of infection To take measures to prevent further spread To trace others who may have been infected To offer advice on enteric precautions and food hygiene To enable early detection of outbreaks

8. Investigation Personal details – date and time of onset – Occupation Food History Details of foreign travel Contact with animals Details of any others ill Specifics for different organisms

9. Control Advise the case and contacts on food and personal hygiene Assess the risk of further spread Trace other contacts Consider need for exclusion Consider follow up to food premises

10. Risk Groups A.Person of doubtful hygiene or poor facilities B.Young children at preschool C.Food handlers D.Care staff

11. Exclusions For certain organisms cases and contacts may need to be excluded E coli 0157 is the organism that this occurs with most EH source cases to be excluded PHA carry out exclusions

12. Guidance PHA – Investigation of Food Poisoning and Gastrointestinal Infections – Regional Guidance for Public Health Practitioners and Environmental Health Officers in NI (2012) Other specific guidance on – E coli VTEC – Typhoid & Paratyphoid – Incident/Outbreak Plan

13. Outbreaks 2 or more unrelated case

14. E. coli O157 Outbreak - 2012 1 st case Tuesday 9 th October 2012 Multi Agency Outbreak Control Team 300 individuals affected 141 clinically confirmed 19 admitted to hospital

15. E. coli O157 Outbreak - 2012 First 9 days worked 15 hour days Voluntary Closure / disposal of food Every food and garnish Every supplier Food, water, environmental samples Interviewed over 300 adults / children Wrote to 3000 businesses

16. E. coli O157 Outbreak - 2012 Source – contaminated food stuff or infected staff member Vehicle of spread – food (some evidence to implicate parsley) Food Handler 1 – may have contributed to spread

17. E. coli O157 Outbreak - 2012 Crown Court 250 exhibits Statements from > 100 cases 11 offences Fined £110,000 (largest ever in NI)

18. Thank you