2009 national western stock show
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2009 National Western Stock Show
2009 National Western Stock Show
E. Coli 0157 outbreak investigation
E. Coli 0157 outbreak investigation
BackgroundBackground
The National Western Stock Show (NWSS) is a yearly event and provides fans with one of the largest assortments of a horse show, livestock, and rodeo in the world.
When: January 10-25, 2009 Where: Denver, CO
The National Western Stock Show (NWSS) is a yearly event and provides fans with one of the largest assortments of a horse show, livestock, and rodeo in the world.
When: January 10-25, 2009 Where: Denver, CO
Additional BackgroundAdditional Background
Big event-650,000+ in attendance Local, national, and international attendees Covers over 100+ acres Many exhibitors Large number of venues, , including
Children’s Activity Pavilion
Big event-650,000+ in attendance Local, national, and international attendees Covers over 100+ acres Many exhibitors Large number of venues, , including
Children’s Activity Pavilion
COOPERATION, PARTNERSHIPSCOOPERATION, PARTNERSHIPS
Although this event occurred in Denver County, the following investigation involved health and environmental departments throughout Colorado, CDPHE, healthcare providers, media, and the Executive Board and staff from the National Western Stock Show.
Although this event occurred in Denver County, the following investigation involved health and environmental departments throughout Colorado, CDPHE, healthcare providers, media, and the Executive Board and staff from the National Western Stock Show.
Collaboration between many partners - Denver metro areaCollaboration between many partners - Denver metro area
CDPHE-Communicable Disease and Consumer Protection Divisions
Denver Environmental Health Denver Public Health Tri-County Health Department Jefferson County Health Department Boulder County Health Department Broomfield Health and Human Services
CDPHE-Communicable Disease and Consumer Protection Divisions
Denver Environmental Health Denver Public Health Tri-County Health Department Jefferson County Health Department Boulder County Health Department Broomfield Health and Human Services
ETIOLOGYETIOLOGY
Escherichia coli (E. coli) O157:H7 is one of over a hundred different serotypes belonging to gram negative bacteria group E. coli
Majority of the E.coli group do not cause human illness
E. coli O157:H7 and a few other serotypes produce potent cytotoxins, called Shiga toxins (STEC)
Escherichia coli (E. coli) O157:H7 is one of over a hundred different serotypes belonging to gram negative bacteria group E. coli
Majority of the E.coli group do not cause human illness
E. coli O157:H7 and a few other serotypes produce potent cytotoxins, called Shiga toxins (STEC)
CLINICAL DESCRIPTIONCLINICAL DESCRIPTION
May be asymptomatic Mild, non-bloody diarrhea Bloody diarrhea Abdominal cramps Nausea and/or vomiting Fever-is usually absent Complications, especially in young children-HUS
May be asymptomatic Mild, non-bloody diarrhea Bloody diarrhea Abdominal cramps Nausea and/or vomiting Fever-is usually absent Complications, especially in young children-HUS
DISEASE REPORTINGDISEASE REPORTING
Reports are received via: Public Providers-physicians, clinicians, infection control
personnel, hospitals, clinics Businesses CDPHE CDC
Reports are received via: Public Providers-physicians, clinicians, infection control
personnel, hospitals, clinics Businesses CDPHE CDC
Timeline of eventsTimeline of events
1/26/09 CDPHE noticed increase in lab confirmed cases of E. coli 0157
1/26-1/30/09-Individual case investigations; suspect common exposure was stock show
2/3/09 visit to NWSS complex 2/3/09 samples sent to CDPHE lab 2/9/09 visit for more samples
1/26/09 CDPHE noticed increase in lab confirmed cases of E. coli 0157
1/26-1/30/09-Individual case investigations; suspect common exposure was stock show
2/3/09 visit to NWSS complex 2/3/09 samples sent to CDPHE lab 2/9/09 visit for more samples
Case numbers:Case numbers:
29 confirmed cases 19 primary cases 10 secondary cases 1 probable case
9 cases hospitalized 2 cases of HUS
29 confirmed cases 19 primary cases 10 secondary cases 1 probable case
9 cases hospitalized 2 cases of HUS
Case DefinitionCase Definition Confirmed- Lab confirmed Onset since January 10 PFGE patterns 00-A/02-F or
00-A/09A
Probable- Diarrhea in a person epi-linked to a
confirmed case
Incubation period-2-10 days
Confirmed- Lab confirmed Onset since January 10 PFGE patterns 00-A/02-F or
00-A/09A
Probable- Diarrhea in a person epi-linked to a
confirmed case
Incubation period-2-10 days
Characteristic Cases
Age in years -- range (median) 1 - 66 (5)note: age missing on 1
probable case
Gender -- n (%)
-Male 7 (23%)
-Female 23 (77%)
County of residence -- n (%)
-Adams 1 (3%)
-Arapahoe 4 (13%)
-Boulder 1 (3%)
-Broomfield 1 (3%)
-Denver 12 (40%)
-Douglas 7 (23%)
-Jefferson 4 (13%)
VISIT FREQUENCIESVISIT FREQUENCIES
Stock Show visit frequencies(Stock Show ran from Jan 10 - 25)
0
1
2
3
4
5
6
7
8
Visit date
Pri
mar
y ca
ses
visi
ts
CASE COUNTSCASE COUNTS
Epi Curve 1: Confirmed "primary" cases (n=19)
0
1
2
3
4
5
01/19
/200
9
01/20
/200
9
01/21
/200
9
01/22
/200
9
01/23
/200
9
01/24
/200
9
01/25
/200
9
01/26
/200
9
01/27
/200
9
01/28
/200
9
01/29
/200
9
01/30
/200
9
01/31
/200
9
02/01
/200
9
02/02
/200
9
02/03
/200
9
02/04
/200
9
02/05
/200
9
02/06
/200
9
02/07
/200
9
02/08
/200
9
02/09
/200
9
02/10
/200
9
02/11
/200
9
02/12
/200
9
02/13
/200
9
Illness onset date
# o
f ca
ses
CASE CONTROL STUDIESCASE CONTROL STUDIES
Coordinated through CDPHE Administered by staff from public health
departments Risk factors-touching certain animals located in
specific areas, i.e. “Kids Zone” and visiting the Stockyards area
Protective factors-visiting the Coliseum area and eating/drinking there; and aware that animals can transmit disease
Coordinated through CDPHE Administered by staff from public health
departments Risk factors-touching certain animals located in
specific areas, i.e. “Kids Zone” and visiting the Stockyards area
Protective factors-visiting the Coliseum area and eating/drinking there; and aware that animals can transmit disease
Challenges for public health partners
Challenges for public health partners
Event was over Sampling and testing methods Entire event revolved around animals and
animal feces Media response Children in daycare
Event was over Sampling and testing methods Entire event revolved around animals and
animal feces Media response Children in daycare
Environmental Investigation
Environmental Investigation
Site visits Walk through of area Sampling of area (3rd floor “Feed the
Animals” exhibit) Answering questions for staff Cleanup
Site visits Walk through of area Sampling of area (3rd floor “Feed the
Animals” exhibit) Answering questions for staff Cleanup
SamplingSampling
50 initial swabs of area. All swabs tested negative for E. coli 0157
4 specimens from floor sweepings and the mats on which animals stood in the “Feed the Animals” area on the third floor. All four tested positive for the identical strain of E. coli O157 found in the ill persons.
50 initial swabs of area. All swabs tested negative for E. coli 0157
4 specimens from floor sweepings and the mats on which animals stood in the “Feed the Animals” area on the third floor. All four tested positive for the identical strain of E. coli O157 found in the ill persons.
Communication and Situation Reports
Communication and Situation Reports
Meetings with NWSS management Daily conference calls between all
parties Individual phone calls, emails, and
CEDRS Coordination with PIO’s
Meetings with NWSS management Daily conference calls between all
parties Individual phone calls, emails, and
CEDRS Coordination with PIO’s
E. coli outbreak linked to Denver cattle show Posted on February 5, 2009 by Doug Powell Health officials are investigating an outbreak linked to Colorado's largest stock show after 20 people, including 17 kids, came down with E. coli O157.
Chris Urbina with Denver Public Health said a lab has confirmed 20 E. coli cases but the number is expected to grow.
The Colorado Department of Public Health and Environment said in a news release,
"While the investigation is ongoing, we suspect that these infections are linked to attending the National Western Stock Show, which was held in Denver from Jan. 10 to Jan. 25.”
Although health officials haven't pinpointed the exact cause of the E. coli, the common denominator in all the cases is the stock show, Urbina said.
Many schools and child care centers organized trips to the stock show, and many children attended with their families, so there is the potential that the number of cases could jump, health officials said.
On Wednesday, the CDPHE sent a letter to daycare centers alerting them to the outbreak and asking the staff to take special precautions.
For disease reporting or other questions please contact the CDPHE Communicable Disease program at 303-692-2700.
Working with the mediaWorking with the media
Dr. Chris Urbina from Denver Public Health was the lead
PIOs coordinated talking points Stock Show CEO conducted
interviews with media
Dr. Chris Urbina from Denver Public Health was the lead
PIOs coordinated talking points Stock Show CEO conducted
interviews with media
Educational opportunitiesEducational opportunities
Attendees Childcare facilities NWSS staff Investigative team
Attendees Childcare facilities NWSS staff Investigative team
Biggest Lesson Learned….Biggest Lesson Learned….
Prevention and future planning for NWSS
Prevention and future planning for NWSS
Focus efforts on exhibits that are geared towards children Provide signage about risks of animal-associated illness
and encouraging hand hygiene, especially at the entrances to areas where animals are housed and areas where food is served/consumed.
Discourage use of sippy cups, pacifiers, bottles, food/beverage in animal contact areas
Provide hand washing facilities with running water and soap
Transition areas prohibiting strollers from entering Move food vendors away from feed the animals area
Focus efforts on exhibits that are geared towards children Provide signage about risks of animal-associated illness
and encouraging hand hygiene, especially at the entrances to areas where animals are housed and areas where food is served/consumed.
Discourage use of sippy cups, pacifiers, bottles, food/beverage in animal contact areas
Provide hand washing facilities with running water and soap
Transition areas prohibiting strollers from entering Move food vendors away from feed the animals area
Why the recommendations?
Why the recommendations?
Since 1996, 100+ human infectious disease outbreaks involving animals in public settings reported to CDC
Risk factors-Direct animal contact and inadequate hand washing
In 2000, two E. coli outbreaks of 0157-H7 in Pa. and Wash. prompted CDC to establish recommendations
Since 1996, 100+ human infectious disease outbreaks involving animals in public settings reported to CDC
Risk factors-Direct animal contact and inadequate hand washing
In 2000, two E. coli outbreaks of 0157-H7 in Pa. and Wash. prompted CDC to establish recommendations
AcknowledgementsAcknowledgements
CDPHE: Alicia Cronquist, Nicole Comstock, Jennifer Sadlowski, Ken Gershman, and Nicole Grisham
DPH/DH: Dee Martinez, Tony Encinias, Dr. Chris Urbina, Dr. David Cohn, Dr. Judith Shlay, Carol McDonald, Stephanie Stark, Lori Kennedy, and Charles Smedly
CDPHE: Alicia Cronquist, Nicole Comstock, Jennifer Sadlowski, Ken Gershman, and Nicole Grisham
DPH/DH: Dee Martinez, Tony Encinias, Dr. Chris Urbina, Dr. David Cohn, Dr. Judith Shlay, Carol McDonald, Stephanie Stark, Lori Kennedy, and Charles Smedly
DEH: Bob McDonald and Abby Bronken
DEH: Bob McDonald and Abby Bronken
Questions????Questions????
Contact InfoContact Info
Carol McDonaldDPH Epidemiology and Surveillance303-602-3626Carol.mcdonald@dhha.org
Abby Bronken DEH Public Health Inspection 720-865-5377 Abby.bronken@denvergov.org
Carol McDonaldDPH Epidemiology and Surveillance303-602-3626Carol.mcdonald@dhha.org
Abby Bronken DEH Public Health Inspection 720-865-5377 Abby.bronken@denvergov.org
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