Foodborne Disease and Outbreaks Update Lynae Granzow, MPH Enteric Epidemiologist

Transcription

1 Foodborne Disease and Outbreaks Update 2007 Lynae Granzow, MPH Enteric Epidemiologist 1

2 What is Food Poisoning? An acute, often severe gastrointestinal disorder vomiting and diarrhea caused by eating contaminated food bacteria, especially bacteria of the genus Salmonella, or the toxins they produce CDC estimates 76 million illnesses annually in the US and 5000 deaths 2

3 What is Food Poisoning to the Public? Diarrhea and/or vomiting Sometimes call the flu Inaccurate, the flu is a respiratory virus and does not cause GI symptoms Occurs immediately after eating the bad food 3

4 GI Symptoms in general Non-infectious Heavy metals: headache Chemicals: tingling/ burning Toxins: visual, neurologic symptoms Food poisoning (bacillus cereus, botulism, clostridium perfringens, staph aureus) Can be immediate symptoms Lasts hours Viral (noro) NO fever Lasts hours 4

5 Symptoms in general Bacterial (campy, salmonella, E. coli) Diarrhea (can be bloody: HUS) Lasts 5-7 days Viral (hepatitis A or E) Jaundice Lasts several weeks Parasitic (crypto, cyclo) Intermittent diarrhea Lasts weeks or months 5

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8 10 Year IN Totals Average Amebiasis Botulism Campylobacter Cryptosporidium Cyclosporidium E.coli O157:H Giardia Hep A Hep E HUS Listeriosis Salmonella Shigella Typhoid Fever Vibrio Yersinia

9 Case Count Year Campylobacter Salmonella Shigella 9

10 Case Count Year Cryptosporidium E.coli O157:H7 Hep A 10

11 Why Does It Take So Long Find an Outbreak? Responds to Investigation Reported and Submitted Stool Sample Collected Seek Medical Treatment Ill Cases with Symptoms 11

12 Most exposures are unknown What if there s no match by DNA analysis Common among the over a thousand confirmed bacterial cases yearly Many exposures are in the home (pets or poor food safety) or person-to-person 12

13 Who Do You Count as a Case? Confirmed laboratory test Need onset date, symptoms, date of exposure Probable symptoms meet the clinical case definition and were exposed Suspect symptoms or exposure are unknown 13

14 Why are There More Outbreaks? Just more identified, but fewer outbreaks than in years past Technology Increases the identification Pulse-field gel-electrophoresis (PFGE) DNA patterning, ie. DNA fingerprint Background cases Better epidemiology investigations Better communication between states and federal agencies 14

15 Communication Federal CDC, PulseNet Federal FDA, USDA State Epi, Lab, and FPP Local 15

16 District Mona Wenger District Donna Allen Lake Newton Porter Jasper LaPorte Starke Pulaski St. Joseph Marshall Fulton Elkhart Kosciusko La Grange Noble Whitley Steuben DeKalb Allen District Brad Beard White Cass Miami Wabash Huntington Wells Adams District Vacant Benton Warren Fountain Tippecanoe Montgomery Carroll Clinton Boone Howard Tipton Hamilton Grant Madison Blackford Delaware Jay Randolph District Stephanie English District 7 & Rob Allen District Karen Gordon Posey Vermillion Parke Putnam Vigo Clay Owen Sullivan Greene Knox Daviess Martin Pike Dubois Gibson Warrick Vandbrg Spencer Hendricks Morgan Marion Johnson Hancock Shelby Monroe Brown Bartholomew Perry Lawrence Orange Crawford Jackson Washington Harrison Floyd Scott Jennings Clark Rush Henry Decatur Jefferson Fayette Ripley District Steve Allen Wayne Franklin Union Dearborn Ohio Switzerland District Sandra Gorsuch 16

17 The ISDH Labs provide testing If the case is symptomatic, directly invovled in an outbreak, without health insurance, or in a high risk profession: Bacterial (7A) Viral (7A) Parasitic (4A) Must contact me before collection/submission Will only test in outbreak situations or if a person is indigent Must have had symptoms in the past 24 hours 17

18 Foodborne Outbreaks and Interesting Cases 2007 Figure 1: Recall actions by specific processor-level problems* (N=1146) * One or more processor level problems may be associated with each recall action USDA. Food GMP Modernization Working Group: Report Summarizing Food Recalls,

19 Salmonella tennessee and PB IN identified 27 PFGE matches At least one reported no symptoms Majority of national cases ate peanut butter regularly 3 jars collected by ISDH for testing 1 matched IN: 48% reported the suspect peanut butter exposure Poor memory Unknown exposure 19

20 S. tennessee Epi Curve IN notified FDA Alert Nov 06 Dec 06 Jan 07 Feb 07 March 07 April 07 May 07 June 07 July 07 20

21 Salmonella enteritidis Outbreak at IHOP Cases:16 Onsets between 2/1/07-3/5/07 Case Control Study Persons who ate at the IHOP (OR=168.00, 95% CI: ) Consumed IHOP eggs (OR=168.00, 95% CI: ) had increased odds of illness Improper temperatures (51 F) of pooled eggs when stored under the grill 21

22 Ongoing Exposure /7 2/8 2/9 2/10 2/11 2/12 2/13 2/14 2/15 2/16 2/17 2/18 2/19 2/20 2/21 2/22 2/23 2/24 2/25 2/26 2/27 2/28 3/1 3/2 3/3 3/4 3/5 Onset Date ate IHOP IN Notified 3/16 22

23 E. coli and PN Steakhouse PN identified 1 case in IN Case consumed rare steak tips Steak tips were mechanically tenderized and injected with marinade April 20, 2007 HFX, Inc., a South Claysburg, Penn., firm, recalled approximately 259,230 pounds of beef products due to possible contamination with E. coli O157:H7 23

24 Notes of an E. coli investigation #1 Mother fed the infant raw hamburger meat because he likes it 24

25 Norovirus Outbreak at a Country Club Cases: 41 Cohort study Persons who worked or ate at the PVCC wedding reception were (CI: ) more likely to become ill than those that did not. While those that ate from the PVCC buffet were (CI: ) more likely to become ill than those that did not. Persons who consumed the cheese were 5.02 (CI: ) times more likely to become ill than those that did not. 25

26 Country Club Exposure Exposure: Two PVCC food handlers reported illness prior to the reception. On May 29th a food handler became ill and later prepared the cheese and crackers. A second food handler became ill on June 2nd in the morning with diarrhea, ending at 5pm, but worked the reception that night. 26

27 Point-source Exposure Pi ne Val l ey Countr y Cl ub Recepti on Rehear sal Di nner 5/ 29 5/ 30 5/ 31 6/ 1 6/ 2 6/ 3 6/ 4 6/ 5 6/ 6 6/ 7 Patron PV Foodhandler Secondary 27

28 Environmental Exposures Biggest concerns: Ill employees Often forced to work Can t afford a day off Return prior to the 24 hours asymptomatic rule Poor hand hygiene Perceived lack of time Lack of food safety knowledge Food temperatures Mass quantities Buffets, banquets, finger foods 28

29 Salmonella wandsworth and Veggie Booty 2 case identified in IN, both infants One case could not clear the infection and was admitted to Riley Organic foods was popular among cases nationwide Both families consumed Veggie Booty regularly June 29: FDA Warns Consumers Not to Eat Veggie Booty Snack Food Risk of Salmonella Contamination Seasoning contaminated 29

30 Salmonella heidelberg Taste of Chicago July 07 Hundreds of suspect cases 9 IN cases identified All consumed hummus shirazi at a Mediterranean vendor Consumption dates from 7/1-7/4 30

31 Notes of an Salmonella investigation #2 While in Florida at a turtle farm, the child put a hatched egg in his mouth and proceeded to eat the sand around it. Case likes to play in dirt and pick through garbage inside home. Has put egg shells in his mouth and attempts to chew on them. 31

32 Salmonella 4,[5],12:i- and pot pies August 07 3 IN cases all consumed chicken pot pies regularly Unknown if the crust, sauce, or ingredients were contaminated Risk Factors Not a pre-cooked item although assumed to be by public Microwave vs. oven USDA Recall: Frozen Chicken and Turkey Pot Pies Banquet brand and generic 32

33 E. coli O157:H7 and frozen pizza November IN case, college student, likely purchased/consumed the pizza while home in Michigan USDA recall on Nov 1: General Mills Operations, a Wellston, Ohio, establishment, recalled an undetermined amount of frozen meat pizza products because they may be contaminated with E. coli O157:H7 Totino s and Jeno s 33

34 Listeria Three cases within 2 weeks of each other across IN. Exposed to unpasteurized dairy products The most severe case: A 23 year old Hispanic women was 34 weeks pregnant Consumed queso fresco. It was sold door to door in the community on Saturdays. She went into a coma and had to be intubated, a machine breathing for her. At this time, they did a C section to save the fetus. 34

35 Notes of a Campylobacter investigation #3 While preparing chicken livers, licked it raw to see if there was enough seasoning. Allowed goats into her home six days prior to her illness. The goats later died. 35

36 Reporting Outbreaks Call ISDH immediately at or (after hours) ISDH will contact the appropriate governmental agencies (CDC, FDA, USDA, and the LHD) Expedite antitoxin Instruct on collection of specimens Investigate possible exposures Consider bioterrorism 36

37 Lynae Granzow, MPH Indiana State Department of Health Enteric Epidemiologist