INVESTIGATIONS. A Puking Primer

Transcription

1 INVESTIGATIONS A Puking Primer

2 Expert Panel Amy Traci Brian

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4 Amy M. Woron Molecular Biologist Select Agent ARO Tennessee Department of Health Nashville, Tennessee Adjunct Professor Department of Public Administration Tennessee State University Nashville, Tennessee Adjunct Instructor National Center for Biomedical Research and Training Louisiana State University Baton Rouge, Louisiana

5 What do I do?

6 Role in Norovirus Outbreaks ROLE Testing is directed by epidemiology Correct most of the time RESPONSIBILITY Results in <5 hours, reflex to culture if needed Sequencing complete within 7 days OSC

7 Future Role Complete validation of Astro / Sapo assay 2 additional microbiologists cert-ready Figure out new workflow with CIDT Example, BioFire noro result only, not Gl / Gll Tweak norovirus awareness project bumper sticker idea not doing well in focus groups

8 Teamwork Laboratory Epidemiology Environmental Health

9 Norovirus Outbreaks in Wisconsin Traci DeSalvo, MPH Epidemiologist Wisconsin Department of Health Services Division of Public Health

10 Public Health in Wisconsin Burnett Polk St. Croix Pierce Western Region Douglas Washburn Barron Dunn Pepin Buffalo Bayfield Saywer Rusk Chippewa Eau Claire Ashland Jackson Trempealeau L acr osse Vernon M onroe Taylor Clark Price Richland Crawford I ron Juneau Wood Sauk Northern Region Vilas Oneida Lincoln M arathon Portage Waushara Adams M arquette Columbia Langlade Waupaca Green Lake For est Shawano Winnebago Fond du Lac Dodge Florence Outagamie M arinette M enominee Oconto Calumet Brown Washington M anitowoc Sheboygan Northeast Region Ozaukee Door Kewaunee Population: 5,726,398 Home-rule state 99 Local and Tribal Health Departments 5 Public Health Regions Wisconsin Division of Public Health (DPH) Southern Region Grant I owa Dane LaFayette Green Rock Jefferson Waukesha M ilwaukee Racine Walworth Kenosha Southeastern Region

11 Norovirus Outbreaks in Wisconsin 5% 6% 9% Setting of confirmed norovirus outbreaks, Wisconsin, % 3% 74% LTCF Restaurant/Caterer School Camp/Youth Recreation Private Home Other Primary mode of transmission of confirmed norovirus outbreaks, Wisconsin, % 3% 1% 8% 86% Person-to-Person Food Water Indeterminate/ Other/ Unknown Environmental Contamination

12 Partnerships for Investigating Norovirus Outbreaks Epidemiology DPH Communicable Disease Epidemiology Section (CDES) DPH Food Safety and Recreational Licensing (FSRL) Local Health Departments and Tribes (LHDs) Local Health Departments and Tribes Wisconsin Department of Agriculture, Trade and Consumer Protection (DATCP) Environmental Health Wisconsin State Laboratory of Hygiene (WSLH) Virology Laboratory

13 Partnerships for Investigating Norovirus Outbreaks Epidemiology CDES Provide consultation and technical assistance Coordinate investigations when outbreaks are multi-county, multi-state, or beyond the capacity of a LHD Authorize testing through the WSLH Provide surge capacity for interviewing and data entry (SOS Team) Environmental Conduct data Laboratory Health analysis and prepare final reports Submit reports to CDC-National Outbreak Reporting System

14 Partnerships for Investigating Norovirus Outbreaks Epidemiology LHDs Compile initial investigation information and coordinate with CDES Facilitate collection and submission of clinical specimens Conduct interviews and case finding Provide Environmental education, exclusions from high-risk settings, Laboratory and other Health interventions Compile line list

15 Partnerships for Investigating Norovirus Outbreaks Laboratory WSLH Provide courier service and specimen collection materials to clinical laboratories and LHDs Conduct Norovirus PCR on all outbreak samples Sequence positive samples from each outbreak Upload sequences to CaliciNet Environmental Health Laboratory

16 Partnerships for Investigating Norovirus Outbreaks Environmental Health Coordinate environmental investigation Conduct the onsite assessment Interview operator and food handlers Collect samples as appropriate Identify contributing factors for the outbreak Environmental Laboratory Health

17 Partnerships for Investigating Norovirus Outbreaks DATCP Environmental Health FSRL/LHDs License and inspect retail food establishments Grocery and convenience stores, bakeries, coffee shops, etc. Regulate food and drink manufactured or produced in Wisconsin Environmental Health Conduct product traceback during outbreak investigations License and inspect restaurants and taverns Also schools, campgrounds, tattoo parlors, hotels, pools, etc. Laboratory

18 Partnerships for Investigating Norovirus Outbreaks Epidemiology Environmental Health Laboratory

19 BRIAN COLLINS, MS, REHS, DAAS DIRECTOR OF ENVIRONMENTAL HEALTH CITY OF PLANO, TEXAS CDC INFORM NOVEMBER 2013 SAN ANTONIO, TEXAS

20 MISSION: Provide outstanding citizen services in environmental/public health, sustainability and animal control that provide wellness and prevent disease and pollution in our community.

21 PERSPECTIVE AND PARTICIPATION (NOROVIRUS) City of Plano is a Texas home rule entity with a health authority and health official. MOU with Collin County Health Services Provide prevention, control and mitigation of certain communicable diseases including norovirus.

22 PLANO ENVIRONMENTAL HEALTH PROVIDES: Prevention/control/education Environmental assessments (pre-post event) Inspection services (routine) Initial environmentnal/epi Investigation Advisement/consultation for prevention/mitigation (post incidence) Post event hotwash/review Liaison with collin county epi/lab

23 COLLIN COUNTY PROVIDES Medical communication (HIPPA) Initial reports/forms Lab support Epidemiological (macro) overview

24 WATERTON IN PLANO NOROVIRUS Assisted and independent living center 60 of 140 residents ill (42.9%) 9 of 50 staff ill (18.0%) Confirmed norovirus via patient labs Initial contact 11/07/12 Case closed 11/15/12

25 QUESTIONS??? BRIAN COLLINS DIRECTOR OF ENVIRONMENTAL HEALTH CITY OF PLANO, TEXAS THANK YOU!

26 . A few days before Thanksgiving

27 Time to shop for all the essentials.

28 What are the typical norovirus symptoms? A. Sneezing, coughing, headaches B. Vomiting, diarrhea, nausea, and feeling like you are going to C. Fever, skin rash, body and muscle aches D. Fever, headache, stiff neck, nausea and vomiting

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30 Nausea sudden takes a nasty turn

31 What is the infectious dose of norovirus? A. <20 particles B particles C particles D. >1000 particles

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33 Sick and embarrassed she leaves the store immediately

34 Store maintenance is paged to clean the mess

35 What should be in the mop bucket to clean up the vomit? A. Soap B. Ammonia C. Bleach D. Hot Water

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37 Who has been exposed? Who could be exposed?

38 How far can vomit travel? A. Up to 2 feet B. Up to 8 feet C. Up to 10 feet D. Not as far as I can run

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40 Day before Thanksgiving preparing food for the Homeless Holiday event

41 Thanksgiving Day

42 And elected officials were there, too.

43 What is the incubation period for norovirus? A hours B. 3-5 days C. 4-7 days D. >7 days

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45 Holiday Travel

46 Two Days after Thanksgiving How is the Health Department notified?

47 What is Kaplan s Criteria A. Incubation period of hours B. Illness lasting hours C. More than 50% of people with vomiting D. All of the above E. Who is Kaplan?

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49 When should samples be collected for norovirus testing? A hours after onset B. 5-7 days after onset C days after onset D. Never, who wants to collect stool or vomit samples

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51 Phylogenetic Tree Pairwise (OG:100%,UG:0%) (FAST:2,10) Gapcost:0% SEQ_RegC-GII Key OutbreakDate 2013-SP SP GII_5_Hillingdon_GBR SP SP SP SP SP SP GII_5_Hokkaido133_JPN03 GII_10_Erfurt546_DEU00 Unrelated September Outbreak Person 1 Thanksgiving Event Participants

52 Grocery Store employee travels back home

53 How can Lab, Epi, EH Keep this outbreak from spreading?

54 When does the media get involved? How does this shape response?

55 Options for preventing spread

56 Norovirus in One Minute

57 Norovirus in One Minute

58 Time to collaborate and disinfect the room Everyone reach down and pick up one or two pom-poms unless you wish to take home a souvenir.

59 M0derat0rs Leslie Barclay CDC Julia Wolfe Orange County, CA Michéle Samarya-Timm Somerset County, NJ

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