2015 Food Borne Illness and more
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Transcript 2015 Food Borne Illness and more
Food Borne Illnesses and more …
Marlene Gaither
EH Program Manager
CCPHSD
CDC Statistics say...
200 known diseases are transmitted through foo
31 million foodborne illnesses annually
Majority are caused by viruses
3000 deaths annually
2014: 4,400 hospitalizations
Main transmission - fecal/oral route
15 FBI Progress Report
Who is responsible for reporting commu
Under , a health care provider, an administrator of a health care
Communicable Disease Code R9-6-203. Reporting Requir
. An administrator of a school, child care establishment, or shelter sha
1. The name and address of the school, child care establishment, or sh
2. The number of individuals with the disease, infestation, or symptom
3. The date and time that the disease or infestation was detected or tha
4. The number of rooms, grades, or classes affected and the name of e
ting Requirements
5. Individual information:
a. Name;
b. Date of birth or age;
c. Residential address and telephone number; and
d. Whether the individual is a staff member, a student, a child in care, or a residen
6. The number of individuals attending or residing at the school, child
7. The name, address, and telephone number of the individual making
Records to health dept/district does not violate hipp
eporting Requirements
FDA Foodborne Illness Report
Major Risk Factors (CDC)
Improper Holding Temperature
Inadequate Cooking
Contaminated Equipment
Unsafe Food Source
Poor Personal Hygiene
Foods Associated w/Foodborne Out
Food Borne Disease
There are more illnesses associ
CDC- Top 5 Pathogens
Pathogen
Estimated number of
illnesses
90% Credible Interval
%
5,461,731
3,227,078–
8,309,480
58
Salmonella,
nontyphoidal
1,027,561
644,786–
1,679,667
11
Clostridium
perfringens
965,958
192,316–
2,483,309
10
Campylobacter spp.
845,024
9
Staphylococcus aureus
241,148
337,031–
1,611,083
72,341–529,417
Norovirus
Subtotal
3
91
SALMONELLA
Salmonella spp.
Disease: Bacterial - about 2,000 known serotypes
Reservoir: Poultry, swine, cattle, rodents, turtles, lizar
Food: Raw meats, poultry, eggs, & dairy products
Infective Dose: 15 to 20 cells
Incubation period: 6 to 48 hours
Salmonella
Symptoms: Nausea, vomiting, abdominal cram
Duration : 1 to 2 days or longer
Associated foods: Raw meat, poultry, eggs, dai
Frequency: 2 to 4 million cases annually
monella Cases
2014 Georgia High School Sports banquet –
56 probable cases
Suspect food smoked chicken
2012 five schools in Illinois –
Infected cook at commercial kitchen preparing meals for
2005 at two elementary schools –
40 probable cases – 26 confirmed
Science clubs dissecting owl pellets did not sanitize table
SHIGELLA
Shigella sp.
Agent - Gram negative bacillus that causes an infecti
Reservoir/Occurrence - Humans/Worldwide
Infective dose – As few as 10 cells
Transmission - fecal/oral route in food and water
I.p.- 1-3 days
Shigella
Symptoms - fever, nausea, vomiting, cramps and ten
Incidence - 300,000 cases annually in US
CFR’s depend on host, but is as high as 20% causes
gella Outbreak
2010 West Virginia at 3 elementary schools
105 cases not fatalities
Transmission occurred at school and at home
Escherichia coli
Escherichia coli 0157:H7
Agent - Gram negative rod shaped bacteria produce
Reservoir/Occurrence - Cattle/N.America,Europe,A
E. coli
Infective Dose ~10 to 15 cells
Transmission - Cross-contamination of infected mea
I.p. - 3-4 days
Symptoms - abdominal cramps, low grade fever, pro
E. Coli Cases
July 2015 in Wisconsin elementary school –
19 students ill
No source has been determined
Summer 2014 in Milwaukee Sizzler sickened 60
E. coli found in raw ground meat that was transf
pylobacter jejuni
Campylobacter jejuni
Disease: Campylobacterosis - curved, and motile rod
Reservoir: Cattle, chickens, birds, and flies
Infective dose: 400 to 500 cells
Incubation period: 2 to 5 days
Symptoms: Watery, stick or bloody diarrhea; fever; a
Campylobacter
I.p. - 2-5 days
Symptoms - diarrhea, abdominal pain, malaise,
CFR - 1 in 1,000 will die – 4 to 6 million cases
Hepatitis A
Hepatitis Vaccination
TWINRIX Vaccine
Ag Dose
e
(ELISA
units)2
Volum No. of
e
doses
(mL)
Schedule
≥
18
yrs
720
1.0
3
0, 1, 6 mos
≥
18
yrs
720
1.0
4
0, 7, 21–30 days
+ 12 mos3
CDC 2015
What is Norovirus?
The genus contains multiple s
Single-stranded RNA, non-env
Genus Norovirus, family Calici
(CDC, 2006; Gerba, 2001)
What do we know about Norovirus?
Causes acute gastrointestinal illness in hu
Noroviruses are highly contagious (both d
Infective dose may be as few as 10 viral p
CDC, 2006
Occurrence of Norovirus
CDC Norovirus leading cause of AGI in U.S.
21 Million per year
800 deaths
50% more illnesses when a new strains introdu
CDC, 2013
Testing for Norovirus
Reverse-transcriptase polymerase chain reactio
Sequencing to determine strain
CDC, 2006
Symptoms of Norovirus
Onset: Often begins suddenly within 1 to 2 days after
Symptoms: Abdominal cramps, nausea, vomiting (pro
Death is rare – common complication is dehydration
CDC, 2006
Is there Immunity to Norovirus?
There is evidence that suggests that immunit
Individuals are likely to be repeatedly infecte
Recent evidence also suggests that susceptib
CDC, 2006
Carriers of Norovirus
Studies with volunteers given stool filtrates hav
“The walking ill”
CDC, 2006
Treatment
To date, there are no antiviral treatments or vaccine for noro
Treatment: Replacement of fluids and electrolytes (prevent
CDC, 2006
How does Norovirus spread?
Transmission: Fecal/oral route involving food, water, person
Evidence exists for transmission to occur through aerosolizat
A person will begin shedding the virus with the start of symp
CDC, 2006
Modes of Transmission Include “Fomit
What are Fomites?
Inanimate objects involved in the spread of disease
Charles P. Gerba
Departments of Soil, Water and Environmental Science and Epidemiology and Environmental Health
Univeristy of Arizona Tucson, AZ
Toilet
Seat
Bath
Counter
Bath
Floor
Kitchen
Floor
Cutting
Board
Bath
Sink
Kitchen
Sink
Sponge
Enteric Bacteria (Coliforms) in the
Teaching: The “Germiest” Profession?
Germs per square inch by occupation
20500
18500
16500
14500
12500
10500
8500
6500
4500
2500
500
s
Te
le
vi
si
on
Co
ns
ul
ta
nt
s
Pu
bl
ic
is
ts
La
wy
er
s
to
r
Do
c
io
Ra
d
ke
rs
Ba
n
s
nt
an
t
Ac
co
u
Te
ac
h
er
s
Average All Sites
one, desk and computer mouse.
Charles P. Gerba
Department of Soil, Water and Environmental Science and
Epidemiology and Environmental Health
Univeristy of Arizona
Tucson, AZ
The most bacteria per square
ms in all Schools – it’s not the Restroom!!
Site
Desk
Computer Mouse
Cafeteria Table
Library Table
Bathroom Sink Faucets
Water Fountain
Keyboard
Bathroom Paper Towel
Handle
Charles P. Gerba
Department of Soil, Water and Environmental Science and
Epidemiology and Environmental Health
Univeristy of Arizona
Tucson, AZ
Percent of sites positive for
Coliforms
59
57
55
53
36
33
33
29
Impact of Disinfectant Wipes on Absenteeism -S
Study
Two school semesters
3rd and 4th graders
Intervention
Children’s desk wiped with a disinfectant wipe at the end o
Results
50% reduction in absenteeism
Bright et al, 2010; J. School Nursing
How long can Norovirus survive in the
Studies indicated that Norovirus may survive:
Up to 4 weeks in “cold” surface water – can survive fre
Temps up to 1400F
Up to 10 ppm free chlorine
4 weeks or more as long as 56 days (Gerba, 2005) on s
CDC, 2006
Sanitizing Surfaces
Recent studies indicate that:
Contaminated fingers can contaminate up to 7 surfaces
Combined chlorine & detergent using 5,000 ppm chlorin
Best Method: Wash with detergent followed by chlorine
NAU Wrestling Outbreak samples
(J. Barker, I. Vipond, S. Bloomfield, 2004)
ractive Exercise
Hot Springs Elementary School K-8 with 350 s
On Monday morning a student vomits in a 5 gr
What are your first steps?
Who should be contacted?
What other information is needed?
Tuesday
The next day a student vomits in the school caf
What needs to be done?
Who should be contacted?
What other information is needed?
What are some of your resources?
Wednesday
20 students in grades 4th & 5th are ill and four more
A teacher with AGI went to a clinic and they stated
More students are falling ill at school and the high s
What control measures may be taken to control the spread
What do you think the causative agent might be?
Thursday
¼ of the students are ill
½ of the cafeteria servers are ill
It has spread to other grades
What do you do?
Who do you contact?
Who will make lunch?
Actual Case
2005 several high school wrestling teams from
July 18th: One student became ill with AGI late
July 20th: ED reported to Health District 3 stud
NAU Case
July 21st: HD visited wrestling camp and interv
Samples were collected: swabbed surfaces – do
tbreak Spreads
Wrestling students are vomiting at lunch buffet
Students from other camps are becoming ill an
115 individuals were ill (53%) from the wrestli
Outbreak peaked on July 20th
Response
An emergency operation center was set-up at N
Sample results were positive for norovirus: toil
Surfaces were disinfected using 5,000ppm chlo
Spread through fomite surfaces and airborne fr