Enterotoxigenic e. coli (ETEC) Outbreak Investigation of a Catered Luncheon. May 4, 2016

Transcription

1 Enterotoxigenic e. coli (ETEC) Outbreak Investigation of a Catered Luncheon May 4, 2016

2 Overview Background information Who we are Outbreak investigation process Case management Caterer investigation Laboratory Findings Epidemiology Outbreak Summary Communications Lessons learned

3 Who we are Brant County Health Unit Population of 136,000 Mix of urban and rural ID team 2 PHIs, 3 PHNs Manager and Director

4 Outbreak Investigation Friday, September 11, 2015 report received Phone call from concerned employee of Brant FACS ill employees 150 staff attended an agency wide meeting on Thursday, September 10, 2015 Menu obtained from Human Resources OUTBREAK DECLARED!

5 Case Management Case questionnaire self administered Contact tracing Stool specimen collection and testing Health teaching

6 Catered Luncheon Mayo transported in large margarine container Mayo on table in margarine containers, no spoons Saran wraps on trays was falling off in transport into facility Trays were stacked on top of each other Food not in cooler bags, but on ice Cookies were transported in a bucket with no lid

7 Catered Luncheon Salads were transported in white buckets Pop and food trays were warm Not enough food Disorganized and unprofessional Lost in transit to facility HEAT ALERT DAY!!!!!!

8 Catering Investigation Inspection of catering operation Approved kitchen Insufficient refrigeration and food preparation space Transported food on ice in bus pans Caterer interviews Obtain food samples Obtain stool sample Section 13 order issued on Sept. 16, 2015

9 Early Outbreak Findings Food safety concerns Negative stool sample results reported Water results were acceptable Epi curve Signs and Symptoms

10 Epi Curve

11 Signs and Symptoms Signs or Symptoms n % Diarrhea Stomach cramps Nausea Headache Chills Muscles aches Fever vomiting

12 Information Gathering - Sept 16, 2015

13 Laboratory Findings Plesimonas shigelloides 2 positives reported 1 st - Presumptive positive Sept. 19, 2015 Confirmed - Sept. 25, nd Presumptive positive Sept. 23, 2015 Confirmed - Sept. 28, 2015 Found in freshwater, estuarine and marine environments Associated with travelers' diarrhea Most strains associated with disease are from patients living in tropical or subtropical areas

14 Or did we

15 Enterotoxigenic e. coli Enterotoxigenic e. coli First report received on Oct. 1, 2015 Non-reportable disease Travelers' diarrhea Generally mild illness, can resemble cholera Sudden onset of diarrhea, rarely fever or vomiting Incubation period 8-48 hours, usually 26 hours High infectious dose

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17 Laboratory Findings 9 (36%) confirmed cases for enterotoxigenic E. coli (ETEC) 25 stool specimens were submitted for testing 8 food samples submitted for testing 1 food sample, egg salad, tested above acceptable limits for total gram negative bacteria

18 Epidemiology 84% response rate for questionnaire (n=134) 78% attack rate (i.e., met case definition), 105 individuals

19 Food Attack Rate Table Symptomatic cases Non-symptomatic cases Food items consumed n Attack rate % n Attack rate % Relative risk Potato salad* Cookies Couscous Ham wrap Egg salad wrap* Greek salad* Turkey wrap Veggie wrap

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21 Outbreak Summary Point source outbreak Confirm the cause of the outbreak was ETEC Confirm the source was the food Confirm the Caterer did not comply with food safety requirements Confirm that the food supplied by the catering company was the source of the outbreak Charges have been laid

22 Communications Requests from Brant FACS for information to staff Fact sheets, website links Town hall meetings Media Social media

23 Communications 20 Facebook posts, with 7 separate conversations 17 Twitter tweets, with 54 separate conversations 5 media releases 14 News articles Brantford, Woodstock, Simcoe and London Barf blog Medical advisory

24 Lessons Learned Incident Management System is helpful Provide input into the Community Outbreak Management Plan Consult with Public Health Ontario and Public Health Laboratory Catering is a complex business Laboratory specimen collection P&P Watch for Red Herrings

25 Many thanks to.. Brant FACS Haldimand Norfolk Health Unit Public Health Ontario and PHO Laboratory BCHU programs Environmental Health Sexual Health Communications Program Evaluation

26 Thank You! Sandi Amorim-Daly Brant Health Unit