Upload
others
View
2
Download
0
Embed Size (px)
Citation preview
Texas Rapid Response Team (TRRT) & Outbreak Response
Tishara Coleman Texas Department of State Health Services
'APID - ftE!iPON!iE
T EAM§
_.,
What is a RRT?
• Rapid Response Team (RRT) • The Food Protection RRTs conduct integrated,
multiagency responses to all-hazards food and feed emergencies in various states across the Nation.
• Multi-year cooperative • FDA • State food regulatory partners.
RRT cooperoti•e Agreement stoles Voluntory RRT States
• ~PID • E!iPON!iE
T EAM!i
■
What is a RRT? • There are currently 24 RRTs nationwide.
RRT History • The RRT program was created to address
the need for improved, integrated rapid response to food and feed emergencies.
• Multi-Agency Collaboration • Between disciplines • Between RRTs • Incident Command System (ICS) principles
TEXAS Health and Human I Texas Depa~ment of State Services Health Serv1CeS
U.S. FOOD & DRU ADMINISTRATION
Texas Rapid Response Team Multiple agencies make up the TRRT and work together to provide preparedness, prevention, and timely response to food and/or feed related disasters that may affect the citizens of Texas.
TRRT Organizational Structure The TRRT follows Incident Command System principles
• What is an Incident Command System (ICS)? • ICS is a standardized on-scene incident management
concept designed to allow responders to adopt an integrated organizational structure equal to the complexity and demands of any single incident or multiple incidents without being hindered by jurisdictional boundaries. -OSHA
Animal FOOD A NO FEED
B RANC,H
Feed Branch
Htanan FOOD B RANCH
Gro up I Group Lead
Group II GroLJp Lea d
Unified Comma nd DSHS/FDA
Public Information
Officer Safety Officer
Planning Chief
Situation Unit Res ource s
Unit
Agency Represenfati11es
Stale Age ncy Dire ctors FDA District Dire ctor FDA Dire ctor FE RN
Logistics Chief
Oocurnentatio n Unit
Demobilization Unit
COMMAND STAFF
GENERAL STAFF
TRRT Organizational Structure
Harvey Texas Rapid Response Team 10/ 02/ 2017
___ ,,.., -----
PmUn;t(Fopdd t..wis Ressl•r
Bra nch Chief (M&D) Hanis Holli ngs1"1orth
Jntjdent Commanders Jane Broussard ( FDA)
Lindsay Bertl ing ( Depu ty FDA) Ben Jones (OTSC)
J ulie Loera ( OS HS)
llllLllllll..EI 1-..(DaQ)
Public Information Officer Tim Hemnan (OTSC)
Operations DSHS
----:~~~/ ~--'-""-'~'"-'"-"-'-' -~ _.... ,' , , ,
Field Team (Foods SE)
FitJd Tgm {l.fb) Sara Williams
Carl ton Peterson Erin Walker John Hsieh
InnaJar.tmillo Linda Menafee
Emma Gorishek Cindy McCormick
Megan Rooney Wei li
Justin Hydock Cheryl Maxwell
Julie Mitchell
Field Team (Foods NE)
fl.t!&.Inm Zach Vice
Shireen Jahedkar Kelsey l ewis Russell Scott
Branch Chief (foods W) l oeWilhams
fje;ld Team (Foods Wl
Harvey 2017
yclospora 2019 Updated 8/26/2019
I O~erations Sect ion
Lori Woznicki
!Incident Commanders Kevin Veal (Lead} Jane Broussard
I j
Planning Section Tishara Coleman
Davonna Koebr i1 ck
Lewis Ressler
I E~idemiolog~ Branch Field Team Documentation Unit
Jlonathon IKollsin Ninfa Carreon (not mobilized) Adrienne Fung Juan Munguia
Samuel Cuevas
Wa rren Chambers
Cyclospora 2019
TRRT Operations • There are four phases of the RRT food and/or feed
emergency cycle. All four of these phases must be completed in sequence. This cycle is continuous.
Deactivation Surveillance Phase Phase
Activation Alert Phase Phase
Activate vs. Response • May activate for large scale investigations involving
food and/or feed and large scale recalls of food and/or feed.
• May respond to events with increased potential public risk.
Activation • Why activate?
• to prevent both ongoing transmission of diseaseand similar outbreaks in the future
Activation
Activation
DSHS
FDA LHDs
TDA
OTSC
Activation
Activation
Activation Triggers • What triggers an activation?
• High probability that an adverse foodand/or feed related incident exists.
• Positive pathogen results • What is the number of cases? • How quickly is the event escalating? • Is the event localized, statewide or
national?
What happens during an activation? • What does the TRRT do?
• Emergency evaluation of food firms andestablishments • Disaster
• Traceback/Product tracing • Foodborne illness outbreak
Emergency evaluation • Natural or man-made emergency events • Ensure that food put in commerce is safe for
consumption
l mpa tcd
Q ounci I of Government
42 & 42 5 Di a tcr Impacted aunties
4 __ 3 Dis• tcr l mpa ·tcd 'aunt ie ·
424 Dis• tcr Impacted ' unt ie ·
' ounty
~i,: 111,:
. '.
Emergency evaluation • Identify affected areas • Survey food firms and establishments • Conduct onsite visit if needed
Traceback • Product Tracing
Verifying the records of a food/feed item from its source to final distribution.
• Traceback An investigation that starts with the consumer or the point-of-service and traces the distribution of the product back to the source.
Traceback • Foodborne illness outbreak
• Confirmed cases • Suspect food item
Traceback
Traceback
I Rtode lsbnd
El p. ID ms:: 11id 111d Irle Fthruliy
rra:i:en pnd
= .. I &p.Dalu::~iy rnsh • F'Nun Graulll
I ~=ntl .
~ Oms: mlHebrua-y H!ll!IITUIII
u111hmb T11111hm . c-..itaflllmm Span (U5 alllm:an
WIim)
Figure .2: Satrlone le Baral'l'ly 1racehack (The d.'s.rrlbutkin of rhe oo.m•sm1'nated runs 18 outfined .IJ'l md.}
b!laurantP Coon!dicLt
&p. Dns: md of retirmrr
rl?:lh Tum
Traceback
TRRT Past Activations and Responses
• 2011 - Salmonella Agona* • 2013 – Cyclospora • 2014 – Cyclospora • 2015 – May Weather Incident • 2015 – Cyclospora • 2016 – Cyclospora* • 2017 – Cyclospora • 2017 - Hurricane Harvey • 2018 – Cyclospora* • 2019 - Cyclospora
·· . ..... . .... - ···
Case Count of Cyclosporiasis in Texas, 2012 •
•.. , -----------D•c..- . ____ .,.,_,,,,,,, __ ., __ ,..,.,.,__,...,..,_...,.)
Cyclospori11sis inTeias. 2014•
C..•Co• •• .,, .. -·· - ···
case Count of CyclosponasIs in Texas, 2013 •
• •. , - ... , .. _. _ _., ... - ~.-~,.-.• -.i;.;-.,. I --~- .. ._.. ,.,,._.er_.,,.,.
--.,, .. -··~ - ···
., -~_,_,...,.,,.._.., .......... ..,......... ........ __ , . ...,..... ""-'
case Count of Cyclosporiasis in Texas, 2015 •
•.. , ,.__.,.,,,.,,.__, ...... ... -~- ..,-·-i;,;-.,. I .. .....,. . ~ ,.,,.__._,,.,.
.,...,. _ __,_,...,.,.,.._,,,,, ....... .., ........... , ............ .,,
Cyclospora Past Activations and Responses
2012 - 44/9 cases 2013 - 351/270 cases
2014 - 200/130 cases 2015 - 316/184 cases
Home > Import Program > Import A lerts > Imports Alerts by Number
Import Alert 24-23
n;cv,:.,u, , lV un:, tt l lf-'Vll M IC tl U CU C'\.I M 1.iyu:. l £ 1 , £ V '" UJ.}U cm:::> U JC' yutua l t\..C' ::>C\..UVI I l U JJIUVNC \..ICU III\..CIUUI I lU VC.l"fMVl \.,M CU IU v v r crM.tV ~I V\...C:>::>e.:i .
Changes are noted and bracketed by three asterisks ('**).
The Centers for Disease Control and Prevention (CDC) and state public health officials have identified annually recurring outbreaks (in 2012, 2013, and 2014) of cyclosporiasis in the United States wh ich have been associated with fresh cilantro from the state of Puebla, Mexico. There is currently (in July 2015) another ongoing outbreak of cyclosporiasis in the United States in wh ich both the Texas Department of State Health Services and the Wisconsin Department of Health Services and the Wisconsin Department of Agricu lture, Trade and Consumer Protection have identified cilan tro from the Mexican state of Puebla as a suspect veh icle with respect to separate illness clusters.
Cyc lospora cayetanensis is a human-specific protozoan parasite that causes a prolonged and severe diarrheal illness known as cyclosporiasis. In order to become infectious, the organism requires a period outside of its host. Illnesses are known to be seasonal and Ille parasite is not known to be endemic to the United states. Cyclosporiasis occurs in many countries. but it seems to be most common in tropical and subtropical regions. People become infected with C. cayetanens is by ingesting sporu lated oocysts. wh ich are Ille infective form of the parasite. This most commonly occurs when food or water contaminated with feces is consumed. An infected person sheds unsporulated (immature. non-infective) C. cayetanenis oocysts in the feces.
Cyclospora FDA Import Alert
Based on epidemiological evidence collected by affected domestic states, the CDC and traceback evaluations conducted by FDA, cilantro from the state of Puebla, Mexico was implicated as the vehicle for some of the U.S. cyclosporiasis infections in 2013 and 2014. In addition, after cyclosporiasis illnesses from the 2013 outbreak were linked to cilantro from Puebla…
Cyclospora Post Import Alert
2016 • DSHS received 120 reports of
cyclosporiasis• 48 domestically acquired cases
2017 • DSHS received 281 reports of
cyclosporiasis• 174 domestically acquired cases
2018 • DSHS received 349 reports of cyclosporiasis• 225 cases domestically acquired cases
i~i~if i%4h§ ~i~l %H%i -hijh Zzl zl 1 1
- s%BH Z~H, ~ §~sH Z3Zl
tlil1 ~h/1 ~1i%i ~14%1 2
~1tli i g%~i~rn 6 ~%~iH r~ H gH H -~hH :%i~1 :%\1 J~i-
■ ~%~~H • ~%~1H I 5Zz19'lzl 5 17/L
• ~H~Hi !@~1~ ■ %~%!~
5'/1'/19 NOOOIO,::tNOOOIO,::tNO N N .-t .-t .-t .-t .-t
saseJ JO JaqwnN
Act
ivat
ion
In D
epth
C
yclo
spor
a 20
19
•D
SH
S r
ecei
ved
63
2 r
epor
ts o
f cy
clos
pori
asis
•4
38
dom
estic
ally
acq
uire
d ca
ses
•Sev
eral
clu
ster
s id
entif
ied
•D
iffer
ent
susp
ect
vehi
cles
RE
PO
RTE
D C
AS
ES
OF
LAB-C
ON
FIR
ME
D,
NO
N-T
RA
VE
L A
SS
OC
IATE
DC
YC
LOS
PO
RIA
SIS
CA
SE
S W
ITH
ILL
NE
SS
ON
SE
T O
N/
AFT
ER
MA
Y 1
, 2
01
9,
TEX
AS
(N=
43
8)
HARIIIY
OLDHAM
HUOSPUH
SHER- HANS- OOlll- LIPSMAN FORD TREE COMB
Activation In Depth Cyclospora 2019
Outbreak-Related Cyclosporiasis Cases in Texas, 2019*
Case Count bv Cluster
- Juice establishment - 13 cases
- Me xican restaurant- 29 cases
- Mexican restaurant- 5 cases
~ Seafood restaurant- 27 cases
- Mexican restaurant- S cases
- Mexican meat market- 9 cases
~ Mexican rest aurant- 3 cases
• As of 9/ 25/ 2019
1--,----,HS R-1-,--......,_-t
TEXAS Health and Human Services
Source: Texas Department of State Health Services, Infectious Disease Control Unit.
Prepared: September, 2019 ( n = 91 )
Texas Department of State Health Services
Activation In Depth Cyclospora 2019
pora 2019 Dallas M etroplex
9/ 4/ 2019 Pathogen: Cyclospora
Veh icle: Cilant ro Exposure Date: 6/ 26
Texas Rapid Response Team
POSA: Irvi ng, TX 1+------1 Dist A:Dallas, TX
Dist B: Mc Allen, TX
Dist C: McAl len, TX
Dist H: Tlaxcala, Dist G: Hida lgo, TX i.---------t Mexico
-------·---·---------·---------·---·----, . . j Dist F: Puebla, , Mexico
Dist D: Puebla, ~c.:.:._ __________________ 7 Mexico
', j Dist E: Jalisco, , Mexico - - - - - - - - - - - - - - - - - - - -
Activation In Depth Cyclospora 2019
■
Cyclospora in Texas Outbreak Related Cases of Cyclosporiasis in
Texas from 2013-2019
500
450
400
350
300
250
200
150
100
50
0
438
174
225
48
130
184
270
2013 2014 2015 2016 2017 2018 2019
IMP
OR
T A
LER
T 2
4-2
3
Outbreak Related Cases of Cyclosporiasis
■
Cyclospora in the U.S. Outbreak Related Cases of Cyclosporiasis in
U.S. from 2013-2019
631
304
546 384
1065
2299
1907
0
500
1000
1500
2000
2500
IMP
OR
T A
LER
T 2
4-2
3
2013 2014 2015 2016 2017 2018 2019
Outbreak Related Cases of Cyclosporiasis
••• I \ \ ··•·
• •• \ \ I •••
What’s Next?
• FDA Food Testing• CDC Sequencing Project
In the meantime…
Surveillance Deactivation Phase Phase
Activation Alert Phase Phase
In the meantime… • TRRT is still active while not activated
• Surveillance phase• Monitor current outbreaks
• Networking/collaboration• Conferences• Calls
2018 RRT Face-2-Face Meeting
In the meantime… • TRRT is still active while not activated
• Training • Traceback course • Online training • Webinars
• Exercises • ICS • Tabletops
• Outreach • Relationship building
• LHDs • Industry
Traceback Investigations course
TEXAS RAPID RESPONSE TEAM
R'Sl fuil•f•IIUi•l•f4thi.f•lfoiMI
Response Operating Guide (ROG)
The TRRT Response Operating Guidelines (ROG) outlines policies for TRRT preparedness, activation, operation, and deactivation.
• Definitions • TRRT members • Policies and
responsibilities • Standard Operating
Procedures (SOPs) • Reviewed and revised
as needed
Sponsor
Food SHIELD Is sponsored by the N3tlonal C11nter for Food
Protection ~nd Defense.
NCFPO 1s a U S Department of Homeland Secunty
Science & Technology Center or Excellence based at lhe Umvers1ty of Minnesota
FoodSHIELD FoodSHIELD is the communication platform for the TRRT.
• Provides public and private food and agriculture sectors an on-line platform to coordinate their efforts in a secure and efficient way.
• Serves as the primary communication and coordination toolduring all phases of a the TRRT emergency cycle.
-----------------------------------------------------------------
~ FoodSHIELD :: V
If Workgroups
IT'l TunRapl'dRespomeTearnPartnen ~ p,., .. ,,~-,,.,.., .... h,,,,,(11,,, .... ,,._~
«: Latest Activity
RRT Loca l and Regional Partners
Post a message or file from here ...
1:57 PM
10:42AM
1/18/17
nshara Coleman replaced Version 1 .0 of Updated ROG 05242016.docx
a Read Current Version J:. Dow nload Current Version
7/22/16
Catherine Thibodaux posted a document At Toi bets From Gordon Food Service
0518201 6_07152016.pdf
a Read J:. Dow nload Current Version 1 .0
A u;.;:;.;g
FoodSHIELD TRRT Local and Regional Partners
TRRT Contact Information
Tishara Coleman Texas Rapid Response Team Coordinator [email protected]