How a foodborne outbreak is inves2gated
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1 North Carolina Produce Safety Professionals Conference Wednesday, March 14, 2018 How a foodborne outbreak is inves2gated
2 NC source and NC inves>ga>on Three Scenarios Out of state source and out of state inves>ga>on Out of state source and CDC inves>ga>on
3 NC source & NC inves2ga2on
4 Partners LHD, Restaurant, Dept of Ag, CDC
5 Out of state source & out of state inves2ga2on
6 Out of state source & CDC inves2ga2on?
7 Outbreak Detec2on Methods PFGE; Increase above the norm; Sampling; Phone calls
8 Ques2ons?
9 Extra Slides Epi Methods (Cohort Study) Line list Epi curve
10 Epi Methods Cohort Study Case-Control Study
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13 Ini&al Stats 150 Ill aqendees 25 Mul&ple Received onsite IV hydra>on EMS trucks onsite 5 Transferred to hospital
14 What partners need to be involved? 4 catered meals during the conference v Environmental Health v Laboratory v Epidemiology
15 What partners need to be involved? 4 catered meals during the conference v Environmental Health v Laboratory v Epidemiology
16 Demographics
17 Symptomology
18 Epi Curve
19 Analytic Study Image credit:
20 What partners need to be involved? 4 catered meals during the conference v Environmenta l Health SLPH: 4 / 9 stools + for NOROVIRUS v Laboratory v Epidemiology Summarizing data; analytic study
21 Epi Curve Norovirus ~24 hr incubation Problem with breakfast
22 Results from analytic study EXPOSED NOT EXPOSED Ill Not ill Total AQack Rate Ill Not ill Total AQack Rate Rel risk CI Mtg rm water 61% 65%.94 Thr pizza 63% 63% 1 Fri bkfst 64% 60% 1.1 Fri lunch Fri dinner
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24 Results from analytic study EXPOSED NOT EXPOSED Mtg rm water Thr pizza Fri bkfst Fri lunch Ill Not ill Total AQack Rate Ill Not ill Total AQack Rate % % % % % % % % 1.1 Rel risk CI (0.8, 1.1) (0.9, 1.1) (0.9, 1.3) (0.9, 1.4) Fri dinner % % 2.6 (1.6, 4.2)
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26 Epi Curve 24 hr incubation Problem with breakfast RR=2.6
27 Epi Curve 10 hr incubation Problem with dinner RR=2.6
28 What partners need to be involved? Found no violations during Hungry Howie s and Sheraton inspection. Centerplate was noted to have cooked chicken to 160F instead of 165F. v Environmenta l Health v Epidemiology SLPH: 4 / 9 stools + for NOROVIRUS v Laboratory CDC: 8 / 9 stools + for Clostridium perfringens enterotoxin; 5 / 6 stools detected the gene for the toxin Something happened during the Friday night banquet dinner
29 Symptomology Symptom Groups Vomi>ng (no D) # % Vomi&ng Diarrhea Individual symptoms Nausea Ab Cramps Other Symptom Only 0 15% with 9 vomiting! 7 2 Diarrhea We d expect more than 50% to have vomited (no V) at the time if norovirus was the cause. V & D Total 310
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32 Epi Methods Line lists
33 33 5. Develop Line List Identifying Information
34 5. Develop Line List Demographic Information 34
35 5. Develop Line List Clinical Information 35
36 5. Develop Line List Laboratory & Case Classification Information 36
37 5. Develop Line List Exposure Information 37
38 38
39 Epi Methods Epi Curves
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46 EPIDEMIOLOGY RESULTS Total Ill 100 Hospitalized 8 Counties Represented 11 Ages 17yrs-81yrs Median: 45 yrs FOOD Exposure Relative Risk Employee Potluck 0.62 Café Breakfast Buffet 0.89 Café Lunch Buffet 1.09 All American Grill 3.6 WORK TASK All American Grill Supervisor 4.3 RESULTS Those who ate/ drank at the All American Grill were 3.6 times more likely to become ill when compared to those who did not eat/drink at the All American Grill
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