OUTBREAKS INVOLVING FOOD & LODGING ESTABLISHMENTS
PARTNERSHIPS NEEDED FOR A SUCCESSFUL INVESTIGATION Carl Williams
Melissa Ham Nicole Lee
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Presentation Content Why do we care about foodborne outbreaks?
What partners need to be involved and why? How does this
partnership work during an outbreak? What are some common conflicts
between partners? Are there resources for partners? Q & A
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Why do we care about foodborne outbreaks?
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Potential illness reaching the masses Intentional vs accidental
contamination Possible wide distribution of a contaminated item
Vulnerable populations Loss of days worked, wages, business,
trust
What partners need to be involved? Environmental Health
Laboratory
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What partners need to be involved? Epidemiology Environmental
Health Laboratory
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What partners need to be involved? Epidemiology Environmental
Health Laboratory
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What partners need to be involved? Epidemiology Environmental
Health Laboratory
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What partners need to be involved? Epidemiology Environmental
Health Laboratory
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What partners need to be involved? Epidemiology Environmental
Health Laboratory
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Purpose of partners Agent specific Verify diagnosis Outbreak
specific Identify source Implement control measures
LaboratoryEpidemiology Facility specific Identify exposure and
transmission opportunities Implement control measures Environmental
Health
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One example When has this worked?
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Real Life Event: Salmonella
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Monday, May 13, 2013 Day 1
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Fifteen ill with N/V/D (some bloody) 10 / 15 hotel staff (3/10
food handlers) 1 hospitalized Two of three samples (+ Salmonella)
May 8 th was the first onset 4pm - Conference call Local Health
Dept: Epi, Env Hlth State: Epi, Env Hlth, Lab, Public Affairs
10:00am Call from CD Nurse
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Day 1 Summary of Actions/Decisions Confirm the story Implement
control measures with hotel/rest. Interview ill Coordinate hotel
assessment with Env Hlth Coordinate stool specimen collection,
shipment, and testing with state lab Develop communication tools
Send statewide & national alerts to identify additional cases
Request receipts from hotel (case-control study) Develop survey
from hotel menu Send state staff to Cumberland to assist with
summarizing data and data entry
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3 Partners with 1 Goal Food & Lodging Outbreak Laboratory
Test stool samples Environmental Health Assess facilities
Epidemiology Coordinate activities Interview patients Characterize
ill Stop the Outbreak
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Activities of partners Test stool Grow isolate Biochem tests
Subtyping PFGE Environmental testing (partner labs) Coordinate
activities Characterize illness Analyze data from all partners
LaboratoryEpidemiology Facility Assessment Processes Employees
Environmental Health
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Results Laboratory Environmental Health Epidemiology
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Laboratory Results 54 specimens tested 2 (4%) unsatisfactory 27
(50%) negative 25 (46%) positive 25 (100%) Salmonella typhimurium
25 (100%) had the same matching PFGE pattern
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Environmental Health Results Environmental Assessments Risk
Factors Personal Hygiene Approved Source Contamination Holding
Cooking Interviews Trainings
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Environmental Health Actions Required reportable BIG 5 Tools
Three legged stool Employee Health Hand washing No Bare Hand
Contact of Ready to Eat food Risk Control Plans Enforcement
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Epidemiology Results Total Ill 100 Hospitalized 8 Counties
Represented 11 Ages 17yrs-81yrs Median: 45 yrs Exposure Relative
Risk FOOD Employee Potluck0.62 Caf Breakfast Buffet0.89 Caf Lunch
Buffet1.09 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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Process Results After outbreaks are over the following
questions are asked of those involved: What worked well during this
outbreak? What did not work well during this outbreak? What
recommendations do you have to improve the handling of future
outbreaks?
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What are some common conflicts between partners?
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Potential conflicts with partners Not aware of numerous
incoming specimens Specimens may be un- satisfactory Interest in
accompanying EH during facility assessments Timing of lab results
can feel delayed LaboratoryEpidemiology Expanded workload
Additional team members on site Environmental Health
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Potential conflicts with partners Feels like state is taking
over instead of assisting Nursing staff pulled from clinic to
address outbreak needs Ensure the county is happy with how the
outbreak is lead Ensuring the same message is communicated to the
public Local Health DeptState Health Dept
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Conflict resolution Establish relationships with partners
before or outside of an outbreak situation Who is your point of
contact and what can they do for you Understand the role of each
partner What do they do and why Do they have the resources the
response requires Communication How often is everyone updated and
through what method Take the opportunity to both learn from others
and share your knowledge
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Are there resources for partners?
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Partnership Resources SLPH website CDC resources MOA with other
states for surge capacity NC Online Communicable Disease Manual
APHL Control of Communicable Disease Manual LaboratoryEpidemiology
NC Food Code Online EH training for Assessments during Outbreaks
http://www.cdc. gov/nceh/ehs/e Learn/EA_FIO/ http://www.cdc.
gov/nceh/ehs/e Learn/EA_FIO/ Environmental Health
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Partnership Resources LaboratoryEpidemiology Environmental
Health
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Partnership Resources LaboratoryEpidemiology NC Food Code Cheat
Sheet Environmental Health
