A Collaborative, Multi-Agency Effort to Prevent SalmonellaNewport Outbreaks Historically-Associated with Tomatoes from Eastern Shore, Virginia

Transcription

1 A Collaborative, Multi-Agency Effort to Prevent SalmonellaNewport Outbreaks Historically-Associated with Tomatoes from Eastern Shore, Virginia 7 th Annual OutbreakNetAnnual Meeting/15 th Annual PulseNetMeeting Wednesday, September 21 st, 2011 Long Beach, CA Seth Levine, MPH Foodborne Disease Epidemiologist Virginia Department of Health Division of Surveillance and Investigation

2 U.S. Foodborne Disease Estimates Approximately 48 million people become ill with foodborne illness annually (1 out of 6 people) 9.4 million foodborne illnesses from known pathogens annually 128,000 are hospitalized 3,000 die

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9 Produce Outbreaks by Commodity Produce Type # of outbreaks Lettuce* 22 Tomatoes 15 Melons** 13 Raspberries 7 Basil 4 Green onions 3 Spinach 3 Mango 2 Parsley 2 Produce Type # of outbreaks Almonds 2 Berries 2 Cabbage 1 Green grapes 1 Jalapeno/Serrano pepp. 1 Snow peas 1 Cilantro 1 Squash 1 Cucumbers 1 * - includes romaine, mixed and unidentified lettuce ** - includes cantaloupe, honeydew and unidentified melons FDA data

10 Tomato Production in the U.S. Second leading tomato producer in world (China is leading producer) Tomato varieties bred for requirements of fresh or processing markets Processing tomatoes accounted for 89% of market in 2008 Florida and California account for 66% -75% of commercially produced, fresh market tomatoes Virginia ranks third in fresh tomato production USDA, ERS data, 2009

11 Popularity of Tomatoes in the U.S. FoodNet Population Survey, Atlas of Exposures,

12 History of Tomato Salmonella Outbreaks in the U.S. Year Serotype # of Cases 1998 S. Baildon S. Thompson S. Newport* 512 S. Newport 12 S. Javiana S. Javiana 471 S. Braenderup S. Newport* 71 S. Braenderup 76 S. Enteritidis S. Newport* 107 S. Typhimurium S. Newport* S. Saintpaul 1442 (tomatoes?/peppers) 2010 S. Newport (suspected)** 46 All S. Newport PFGE pattern 61 Source of tomatoes was Eastern Shore, VA *Same PFGE pattern FDA data

13 S. Newport Pattern JJPX First enzyme (Xbal) comprises 3.46% of all S. Newport patterns in Sitescape (1,261/36,489) Year # of VA Cases VA Onset Date Range 2006* * 8 6/9/07-8/9/ /27/08-9/29/ /19/09-11/05/ /14/11-10/14/ /21/11-8/1/11 VarmaJK, et al. Highly resistant Salmonella Newport MDRAmpCtransmitted through the domestic food supply: a FoodNet case-control study of sporadic Salmonella Newport infections, Journal of Infectious Diseases 2006; 194:

14 S.. Newport and Pattern JJPX All S. Newport JJPX PulseNet uploads per week MDJJP-1ml 0311VAJJP-2c 0409PAJJP-1c 0509NHJJP PAJJP-1c 0708NYJJP-1c 0812MLJJP-1c

15 CDC. An Atlas ofsalmonella in the United States: serotype-specific surveillance

16 CDC. An Atlas ofsalmonella in the United States: serotype-specific surveillance

17 CDC. An Atlas ofsalmonella in the United States: serotype-specific surveillance

18 CDC. An Atlas ofsalmonella in the United States: serotype-specific surveillance

19 Eastern Shore, Virginia: Part of the Delmarva Peninsula Eastern Shore, Virginia Delmarva Peninsula

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22 22 Contamination Sources ON THE FARM Four Sources of Particular Importance Soil Water Farm Workers Domestic and Wild Animals

23 Potential Sources of Contamination 23

24 Multi-Agency Collaborative FDA/CFSAN Virginia Department of Health (VDH) Virginia Department of Agriculture and Consumer Services (VDACS) Division of Consolidated Laboratory Services (DCLS) Virginia Tech University: Eastern Shore Agricultural Research and Extension Center (VT AREC) Virginia State University

25 Three Pronged Approach Education and good agricultural practices (GAPS) training of tomato farmers and packinghouse staff Environmental sampling on the Eastern Shore of Virginia Targeted interviewing of Virginia Salmonella Newport case-patients with PFGE patterns of interest (61, 30 and 11)

26 Education and GAPS Training FDA, VDACS, VDH, VT AREC prepared and provided presentations for tomato farm staff One hour presentations provided to farm staff in English and Spanish All three tomato growers participated Tours and informal training for management provided at three tomato packinghouses

27 Environmental Sampling on the Eastern Shore: THE GOOD Approximately 250 animal/environmental samples collected from eastern VA (primarily ES) Sources include turtles, seagulls, ducks, deer, horse, snake, pigs Approximately 25 isolates identified (primarily turtles and seagull droppings)

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29 Environmental Sampling on the Eastern Shore: THE BAD

30 Environmental Sampling on the Eastern Shore: THE UGLY

31 Targeted Interviewing of S. Newport Case-Patients

32 Targeted Summer Supplemental Interviewing Results Pattern # of Cases Completed Supp. Quest

33 Targeted Summer Supplemental Interviewing Results Exposures of Interest: SN pattern 30, 26 y.o. female from northern VA, onset of illness 7/6/11, vacationed on Eastern Shore, VA 7/2-7/5, heavy tomato consumption including MD Eastern Shore Tomato stand Reported to FDA and they had sampled from same tomato stand in the same time frame and got two positive Salmonella hits off tomatoes; awaiting serotype/pfge results SN pattern 30, 31 y.o. male from northwest VA, onset of illness 7/16/11, spent time at mom s house in Delaware, Eastern Shore, heavy tomato consumption including DE tomato stand Other lesser exposures of interest included a landscaper, a hunter of wild game and fish and a child from Eastern Shore with relatives working in a poultry processing plant

34 Future Goals Consider replicating three-pronged efforts next year Develop self-administered web-based training for tomato growers and packinghouse staff Work with industry early on if any suspicions of outbreak arise Build trust amongst industry Consider new partners in determining source of contamination: FDA CORE, USDA, Department of Environmental Quality, Department of Game and Inland Fishery, hydrologists

35 Questions??

36 Extra Slides

37 Soil 37

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42 Wildlife 42

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45 Water 45

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50 Workers 50

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53 The Packinghouse 53

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58 You can t wash it off 58

59 59 Chlorine ph Temperature Comparing to monitor

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61 Field Packing by Pinhookers 61

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